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MRI rules out acute appendicitis in pregnancy
February 28, 2006Magnetic resonance imaging (MRI) can help rule out acute appendicitis in pregnancy when ultrasound findings are inconclusive, according to a study in the March issue of Radiology.
Until now, in cases where appendicitis is strongly suspected and ultrasound is inconclusive, computed tomography (CT) has been the method physicians rely on for further investigation. However, this technique involves the use of ionizing radiation, which is less desirable during pregnancy because of potential harm to the fetus.
"MRI can potentially spare thousands of women and their developing fetuses from exposure to radiation by minimizing the need for CT to rule out appendicitis," said Dr. Ivan Pedrosa, M.D., lead author of the study from Beth Israel Deaconess Medical Center and assistant professor of radiology at Harvard Medical School in Boston.
Dr. Pedrosa's study constitutes the largest series of pregnant women with abdominal pain evaluated with MRI to date. Abdominal pain is a common complaint during pregnancy, and physicians are challenged with recognizing situations where emergency surgical intervention is necessary. Appendicitis is the most common cause of belly pain requiring emergency surgical treatment in pregnant women.
Typically, ultrasound is the preferred method for imaging the appendix in pregnant women, but the enlarged uterus and other physiologic changes-particularly during the third trimester-may prevent ultrasound from effectively visualizing the appendix, rendering the exam inconclusive.
In Dr. Pedrosa's study, 51 pregnant women underwent MRI after complaints of abdominal pain. Forty-eight of the women had a prior ultrasound exam. MRI yielded four diagnoses of acute appendicitis. Two of these four cases were not detected with ultrasound.
"Our study clearly demonstrates the capability of MRI when evaluating pregnant patients suspected of having appendicitis," said Dr. Pedrosa. "Additionally, MRI can reveal other conditions that may masquerade as appendicitis clinically, without unnecessary radiation exposure."
Dr. Pedrosa and colleagues believe that their findings support a change in clinical practice, by replacing CT with MRI as the definitive method of investigating abdominal pain in pregnant women.
"CT should be reserved for rare cases where MRI is inconclusive and there is strong clinical concern for appendicitis," he said.
At Beth Israel Deaconess Medical Center, the examination procedure has changed to reflect Dr. Pedrosa's findings.
"We eliminated what was a common practice, using CT to examine pregnant women with inconclusive ultrasound results," he said. "Now, these patients are evaluated with MRI instead."
However, Dr. Pedrosa maintains that larger studies are needed to investigate the issue of patient outcomes and examine the reproducibility of their results. Until now, only small series of pregnant women have been evaluated with MRI.
Appendicitis occurs when the appendix becomes acutely inflamed and develops a severe infection. The importance of ruling out this and other conditions that may require surgical intervention is paramount, to avoid unnecessary delays in treatment and subsequent risks to both mother and developing fetus.
Radiological Society of North America
Dr. Pedrosa's study constitutes the largest series of pregnant women with abdominal pain evaluated with MRI to date. Abdominal pain is a common complaint during pregnancy, and physicians are challenged with recognizing situations where emergency surgical intervention is necessary. Appendicitis is the most common cause of belly pain requiring emergency surgical treatment in pregnant women.
Typically, ultrasound is the preferred method for imaging the appendix in pregnant women, but the enlarged uterus and other physiologic changes-particularly during the third trimester-may prevent ultrasound from effectively visualizing the appendix, rendering the exam inconclusive.
In Dr. Pedrosa's study, 51 pregnant women underwent MRI after complaints of abdominal pain. Forty-eight of the women had a prior ultrasound exam. MRI yielded four diagnoses of acute appendicitis. Two of these four cases were not detected with ultrasound.
"Our study clearly demonstrates the capability of MRI when evaluating pregnant patients suspected of having appendicitis," said Dr. Pedrosa. "Additionally, MRI can reveal other conditions that may masquerade as appendicitis clinically, without unnecessary radiation exposure."
Dr. Pedrosa and colleagues believe that their findings support a change in clinical practice, by replacing CT with MRI as the definitive method of investigating abdominal pain in pregnant women.
"CT should be reserved for rare cases where MRI is inconclusive and there is strong clinical concern for appendicitis," he said.
At Beth Israel Deaconess Medical Center, the examination procedure has changed to reflect Dr. Pedrosa's findings.
"We eliminated what was a common practice, using CT to examine pregnant women with inconclusive ultrasound results," he said. "Now, these patients are evaluated with MRI instead."
However, Dr. Pedrosa maintains that larger studies are needed to investigate the issue of patient outcomes and examine the reproducibility of their results. Until now, only small series of pregnant women have been evaluated with MRI.
Appendicitis occurs when the appendix becomes acutely inflamed and develops a severe infection. The importance of ruling out this and other conditions that may require surgical intervention is paramount, to avoid unnecessary delays in treatment and subsequent risks to both mother and developing fetus.
Radiological Society of North America
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Acute Appendicitis and its Complications [Oxford Medical Publications] by Frederick Fitzherbert Boyce (Author) | |
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Eliminate Decoction (Da Huang Mu Dan Tang) 60 Capsules X 3 by Made in China Eliminate Decoction (Da Huang Mu Dan Tang). Packing: 60 capsules per box, each capsule contains 600mg. Product of China. Notes: Eliminate Decoction is a prepared formula of the classic TCM prescription from Synopsis of the Golden Chamber, "Da Huang Mu Dan Tang (Rhubarb and Moutan Bark Decoction)". In modern clinic, it is applicable to acute appendicitis, acute pelvic inflammation, acute annexitis due to the accumulation of dampness and heat, with the symptoms of fever, perspiration, pain and tenderness in the right lower abdomen or with limitation of the right foot to stretch without formation of pus. Modern research has proved that this combination has the effects of relieving inflammation, existing bacteria, improving circulation, and discharging pus. |
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The art and science of diagnosing acute appendicitis.(Editorial): An article from: Southern Medical Journal by Mike K. Liang (Author) This digital document is an article from Southern Medical Journal, published by Thomson Gale on December 1, 2005. The length of the article is 994 words. The page length shown above is based on a typical 300-word page. The article is delivered in HTML format and is available in your Amazon.com Digital Locker immediately after purchase. You can view it with any web browser. Citation Details Title: The art and science of diagnosing acute appendicitis.(Editorial) Author: Mike K. Liang Publication: Southern Medical Journal (Magazine/Journal) Date: December 1, 2005 Publisher: Thomson Gale Volume: 98 Issue: 12 Page: 1159(2) Distributed by Thomson... | |
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Acute Appendicitis: Standard Treatment and the Role of Laparoscopic Surgery (Progress in Surgery) (v. 25) by L. Krahenbuhl (Editor) This study reviews approaches to acute appendicitis. It compares the benefits and costs of open versus laparoscopic appendectomy, examining exact diagnosis of right iliac fossa pain, wound infection rate and the use of laparoscopic techniques in different patient catagories. |
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Race, no-insurance status linked to perforation in acute appendicitis: nationwide database.(Children's Health): An article from: Family Practice News by Betsy Bates (Author) This digital document is an article from Family Practice News, published by International Medical News Group on April 15, 2004. The length of the article is 1577 words. The page length shown above is based on a typical 300-word page. The article is delivered in HTML format and is available in your Amazon.com Digital Locker immediately after purchase. You can view it with any web browser. Citation Details Title: Race, no-insurance status linked to perforation in acute appendicitis: nationwide database.(Children's Health) Author: Betsy Bates Publication: Family Practice News (Magazine/Journal) Date: April 15, 2004 Publisher: International Medical News Group Volume: 34 Issue: 8 Page: 85(1) Distributed by Thomson... | |
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Acute cecal diverticulitis mimicking appendicitis in a 16-year-old female.(Section on Emergency Medicine): An article from: Southern Medical Journal by Antonio E. Muniz (Author), Steve Liner (Author), Sam Bartle (Author), Chris Woleben (Author), Robin L. Foster (Author) This digital document is an article from Southern Medical Journal, published by Southern Medical Association on October 1, 2004. The length of the article is 668 words. The page length shown above is based on a typical 300-word page. The article is delivered in HTML format and is available in your Amazon.com Digital Locker immediately after purchase. You can view it with any web browser. Citation Details Title: Acute cecal diverticulitis mimicking appendicitis in a 16-year-old female.(Section on Emergency Medicine) Author: Antonio E. Muniz Publication: Southern Medical Journal (Refereed) Date: October 1, 2004 Publisher: Southern Medical Association Volume: 97 Issue: 10 Page: S9(2) Distributed by Thomson... | |
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Right ureteral calculus simulating acute appendicitis by Montague Laffitte Boyd (Author) | |
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Data obtained through correspondence with nine hundred general practitioners and surgeons relative to the diagnosis, treatment and classification of acute appendicitis by Frank David Smythe (Author) | |
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Acute appendicitis in adults: Epidemiologic, pathogenetic, diagnostic and socioeconomic aspects (Bulletin of the Department of Surgery, University of Lund) by Einar Arnbjörnsson (Author) |
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