Figure 1
Figura 1
A 1.5 T T1-weighted MRI coronal slice: an anatomical overview.
MRI features of acute non-perforated appendicitis at 1.5 T
SectionAbdominal imaging
Case TypeClinical Cases
AuthorsChabanova E, Løgager V, Thomsen HS
Connected authors
70 years, male
Clinical History
A patient presented with right lower quadrant tenderness, abdominal guarding and rectal tenderness and he had leucocytosis.
Imaging Findings
The patient had experienced right lower quadrant pain for 2 days and the pain increased during movement. He had no fever, nausea or vomiting. A physical examination done revealed right lower quadrant
tenderness, abdominal guarding and rectal tenderness. Furthermore, he had leucocytosis. The clinical features suggested the possibility of acute appendicitis. As part of a current work-up, MRI was
performed. 1.5 T STIR MR imaging confirmed the presence of intraluminal fluid, a thickened appendix wall and infiltration of periappendical fat (Figs. 1-3). In addition, the appendix diameter was
measured to be 1 cm. The patient subsequently underwent surgery. Acute appendicitis was confirmed by means of surgery and by microscopy.
Discussion
Acute appendicitis can be difficult to diagnose clinically due to the presence of atypical symptoms. Male patients (10%–15%) and up to 45% of female patients undergo false-negative laparotomy
[1] . In some situations, an ultrasound examination is used to clarify the symptoms [2,3]. Nevertheless, the limiting factors pretaining to the use of ultrasound include a retrocecal location and
obesity of the patients. Sometimes CT is used when the ultrasound investigation happens to be inconclusive. Although MRI reveals the anatomy similarly to as done on CT, it has a major advantage in
that it is a nonionizing technique. MRI is shown to be more specific in determination of acute appendicitis relatively to ultrasound [4,5]. Due to technological development in the past years, MRI has
become a widely used diagnostic method, which will soon be available in most hospitals. The inflammed appendix and surrounding fat show a significant MR signal enhancement on T1-weighted images after
administration of an intravenous MR contrast injection [4]. Appendicitis can also be identified by MRI even without giving an MR contrast injection. MRI STIR sequences, which are especially sensitive
to fluid collections are fast and show a good resolution with slices of 2–4 mm. The present case illustrates, how MRI can be used for identification of acute non-perforated appendicitis without
administration of an MR contrast injection.
Differential Diagnosis List
Acute non-perforated appendicitis.
Final Diagnosis
Acute non-perforated appendicitis.
References
[1] Curtin KR, Fitzgerald SW, Nemcek AA Jr et all. CT diagnosis of acute appendicitis: imaging findings. AJR 1995; 164:905-909. (PMID: 7726046)
[2] Incesu L, Coshkun A, Selcuk MB et all. Acute Appendicitis: MR Imaging and Sonografic Correlation. AJR 1997; 168:669-674. (PMID: 9057512)
[3] Hörmann M, Paya K, Eibenberger K et all. MR Imaging in children with nonperforated acute appendicitis: value of unenhanced MR imaging in sonografically selected cases. AJR 1998; 171:467-470. (PMID: 9694477)
Case information
| URL: | https://eurorad.org/case/3369 |
| DOI: | 10.1594/EURORAD/CASE.3369 |
| ISSN: | 1563-4086 |
Figure 2
Figura 2
A 1.5 T STIR MRI coronal slice (corresponding to that in Fig. 1) showing the inflamed appendix (white arrow) with infiltration of the surrounding area.
Figure 3
Figura 3
A 1.5 T STIR MRI axial slice showing the inflamed appendix (white arrow) with infiltration of the surrounding area. The appendix diameter was measured to be 1 cm.
Figura 1
A 1.5 T T1-weighted MRI coronal slice: an anatomical overview.
Figura 2
A 1.5 T STIR MRI coronal slice (corresponding to that in Fig. 1) showing the inflamed appendix (white arrow) with infiltration of the surrounding area.
Figura 3
A 1.5 T STIR MRI axial slice showing the inflamed appendix (white arrow) with infiltration of the surrounding area. The appendix diameter was measured to be 1 cm.