Open-access 12-minute MRI screening for acute appendicitis: a five-year retrospective observational study of diagnostic accuracy

Andrew Owen Jones, James Nol

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Abstract

Objective: This retrospective observational diagnostic accuracy study aims to demonstrate that open-access rapid-sequence non-contrast magnetic resonance imaging (MRI) is accurate for exclusion or confirmation of acute appendicitis (AA). Methods: In 2017, a locally designed 12 min MRI protocol was made available as a new open-access option (no booking needed) for any emergency department (ED) or acute surgical patient with any clinical presentation at the authors’ sites. Uninterrupted single-radiologist reporting availability was provided. A 5-year consecutive report list from 1 January 2019 to 31 December 2023 was recorded in an activity log, from which 3478 eligible reports were identified as ED-based referrals assessing for possible AA. There was “appendicitis possibility” in 581/3478 (17%) reports and “no evidence of appendicitis” in 2897/3478 (83%). These were retrospectively compared with the medical record findings of 557/3478 proven cases of AA (16%). Report availability and reliability metrics have been assessed. Results: Overall, 2583/3478 reports (74%) were finalized within 2 h of MRI study completion, 3254/3478 (94%) within 4 h. The 3478 reports combined had 98% sensitivity, 98% specificity, 98% accuracy, 94% positive predictive value, and 99% negative predictive value for AA (φ = 0.95). The largest 5-year subgroup, females 15–19 years old, 66/440 with proven AA, had 98% report accuracy. Pregnant women, 21/171 with proven AA, had 99% report accuracy. Conclusions: The described MRI protocol is accurate for appendicitis assessment and is a suitable first-imaging choice for children, young adults, and pregnant women. It does not require intravenous contrast and poses no radiation risk.

Original languageEnglish
Article number7257
Number of pages18
JournalJournal of Clinical Medicine
Volume13
Issue number23
DOIs
Publication statusPublished - 2024

Keywords

  • accuracy
  • appendicectomy
  • appendicitis
  • diagnostic imaging
  • magnetic resonance imaging
  • sensitivity
  • specificity

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