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MRI of appendicitis in pregnancy

Case Study
Punjabi, Gopal, M.D. Hennepin County Medical Center • USA
Truwit, Chip, MD, FACR Hennepin County Medical Center • USA

Patient history

A 25-year-old female, 20 weeks pregnant, presented with right lower quadrant pain.
Her white blood cell count was elevated, measuring 14.6. Ultrasound failed to visualize the appendix. Then the patient was referred for MRI at Hennepin County Medical Center (Minneapolis, Minnesota, USA)

MR examination

The exam was performed on a Achieva 1.5T dStream system using the integrated Posterior coil and the Anterior coil.

The exam includes 3-plane T2-weighted scans, 3-plane B-FFE scans and axial T2W SPAIR, all in breath holds not longer than 15 seconds.

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Images

Click on an image to enlarge.
 T2 TSE<br><br> T2 SPAIR<br><br>
T2 TSE

T2 SPAIR

 T2 TSE<br><br> T2 TSE<br><br>
T2 TSE

T2 TSE

Diagnosis

The MR images demonstrate a distended appendix with adjacent fat stranding.
The diagnosis is acute non-perforated retrocecal appendicitis, surgically confirmed.

Clinical impact

MRI successfully supports diagnosing appendicitis in pregnancy without using ionizing radiation or contrast. This 18-minute exam without contrast or ionizing radiation has replaced CT in pregnant women at our institution. We have performed over 60 cases in the last 5 years, with 9 positive, surgically confirmed. We saw no false positives, and to the best of our knowledge, no false negatives either. We usually start with ultrasound, but it is frequently negative in these patients.

 

T2-weighted sequences are the mainstay for our diagnosis. With our SmartPath to dStream system, SENSE and dStream allow us to acquire these faster with improved signal. In these patients, who are often short of breath, the scan can be completed in 15 minutes or less.

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Dec 4, 2014

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Case Study
Achieva 1.5T dStream
appendicitis, Body, dStream, pregnancy, SmartPath to dStream, Women's health
 

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