Apendicitis

Radiology

Gastrointestinal Imaging
Aytekin Oto, MD
Randy D. Ernst, MD
Rajeev Shah, MD
Mert Koroglu, MD
Gregory Chaljub, MD
Alfredo F. Gei, MD
Nikolaos Zacharias, MD
George Saade, MD
Published online before print
10.1148/radiol.2341032002
Radiology 2005; 234:445– 451
Abbreviation:
SE spin echo
1

From the Departments of Radiology
(A.O., R.D.E., R.S., M.K., G.C.) and
Obstetricsand Gynecology (A.F.G.,
N.Z., G.S.), University of Texas Medical Branch at Galveston, 301 University Blvd, Galveston, TX 77555-0709.
Received December 9, 2003; revision
requested February 17, 2004; final revision received April 4; accepted May
12. Address correspondence to A.O.
(e-mail: ayoto@utmb.edu).
Authors stated no financial relationship to disclose.

Right-Lower-Quadrant Pain
andSuspected Appendicitis in
Pregnant Women: Evaluation
with MR Imaging—Initial
Experience1
PURPOSE: To determine if there is a role for magnetic resonance (MR) imaging in
evaluation of pregnant women with acute right-lower-quadrant pain in whom acute
appendicitis is suspected.
MATERIALS AND METHODS: Informed consent and institutional review board
approval were obtained. Images obtained with a1.5-T MR imager and medical
records of 23 pregnant women (age range, 19 –34 years; mean age, 24.7 years) who
presented with acute right-lower-quadrant pain were retrospectively reviewed. MR
protocol included use of transverse, coronal, and sagittal noncontiguous T2-weighted
single-shot fast spin-echo (SE) sequences; transverse fat-suppressed T2-weighted fast SE
sequences; transverseT1-weighted gradient-recalled-echo sequences; and transverse
and coronal short inversion time inversion-recovery sequences performed through the
lower abdomen and pelvis. MR findings were evaluated by two radiologists and
compared with surgical and pathologic findings and clinical follow-up data.
RESULTS: Appendix was detected in 20 (86.9%) of 23 patients. Seven patients
underwent surgery; four hadacute appendicitis, and three had ovarian torsion. Two
patients with pelvic abscesses not related to appendicitis underwent percutaneous
drainage. Fourteen patients were treated medically. Dilated thick-walled appendix
and periappendiceal inflammation were detected in three (75%) of four patients
with acute appendicitis. In one patient with appendicitis, the appendix could not be
visualized, butinflammation was present in the right lower quadrant. In three
patients with ovarian torsion, MR imaging demonstrated right adnexal mass or
inflammation. MR imaging was used to correctly identify pelvic abscesses and
healthy appendix in two patients. A healthy appendix was depicted in 17 (89.5%)
of 19 patients without acute appendicitis.

Author contributions:
Guarantor of integrity of entirestudy,
A.O.; study concepts, N.Z., G.C., R.S.,
M.K., A.O., R.D.E., G.S.; study design,
A.F.G., A.O., R.D.E., R.S., G.S.; literature research, A.O., M.K., A.F.G.; clinical studies, A.O., R.D.E., G.S., R.S.;
data acquisition, all authors; data analysis/interpretation, A.O., R.S., R.D.E.,
G.S.; manuscript preparation and definition of intellectual content, A.O.,
M.K., R.D.E., G.S.; manuscriptediting,
R.D.E., M.K., G.S.; manuscript revision/review and final version approval,
all authors
©

RSNA, 2004

CONCLUSION: MR imaging shows promise for evaluation of pregnant women in
whom acute appendicitis is suspected by enabling diagnosis of other possible causes
of right-lower-quadrant pain, including ovarian torsion or pelvic abscesses, and
demonstrating a healthy or unhealthyappendix.
©

RSNA, 2004

Acute appendicitis is the most common cause of acute abdomen during pregnancy,
occurring in approximately one in 1500 deliveries (1). Altered anatomic location of the
appendix in pregnant women and similarity of signs and symptoms of normal pregnancy
and acute appendicitis are the two most important factors leading to difficulties in
diagnosis. Pain in the right lower...