NVvR Travel Grant 2011
voor aios radiologie met het beste wetenschappelijk werk dat zowel geaccepteerd is voor presentatie op de Radiologendagen 2011 als op de RSNA 2011.
Marjolein Leeuwenburgh, AMC Amsterdam
OPTIMAL STRATEGY IN PATIENTS WITH SUSPECTED ACUTE APPENDICITIS, CAN MRI REPLACE CT?
M.M.N. Leeuwenburgh1, H.W. van Es2, J.W.C. Gratama3, P.M.M. Bossuyt1, M.A. Boermeester1, J. Stoker1, OPTIMAP Studiegroep 1 Academisch Medisch Centrum, Amsterdam
2 St. Antonius Ziekenhuis, Nieuwegein
3 Gelre ziekenhuizen, Apeldoorn
Purpose: To identify the optimal imaging strategy in adult patients with suspected appendicitis.
Methods: We included consecutive patients with suspected appendicitis in six hospitals. Patients underwent initial US, followed by CT in case of nondiagnostic US results. Additionally, all patients underwent MRI (HASTE, HASTE SPAIR, DWI), with the MRI reader blinded for the results of the other imaging methods. An expert panel assigned a final diagnosis based on histopathology and clinical follow up after 3 months. We evaluated the sensitivity and specificity of the following scenarios: (1) US only;(2) US in all patients followed by CT after a non-diagnostic US;(3) US followed by MRI after a non-diagnostic US;(4) MRI only.
Results: We performed 229 US, 126 CT and 223 MRI examinations in 230 patients (mean age 38 years, 41% male). Acute appendicitis was assigned as final diagnosis in 118 patients (51%). Sensitivity of US only was 0.76(95%CI: 0.68-0.83); specificity 0.94(95%CI: 0.88-0.97). Conditional imaging strategies with CT or MR after a non-diagnostic US resulted in a significantly increased sensitivity (p<0.001) of 0.97(95%CI: 0.93-0.99) and 0.99(95%CI: 0.95-1.00) and a specificity of 0.91(95%CI 0.84-0.95) and 0.88(95%CI 0.81-0.93) respectively. Conditional strategies with CT and MRI had comparable results for sensitivity and specificity (p=0.500, p =0.453). The MRI only strategy had a high sensitivity (0.97, 95%CI: 0.92-0.99) and specificity (0.93, 95%CI: 0.87-0.97).
Conclusion: Using US only would miss too many patients with acute appendicitis. Additional CT or MRI after a non-diagnostic US improves accuracy. An MRI only strategy could be an alternative approach.
Marjolein Leeuwenburgh, AMC Amsterdam
Marjolein Leeuwenburgh, AMC Amsterdam
Marjolein Leeuwenburgh, AMC Amsterdam
