MRI对评估右下腹疼痛的怀孕妇女是有潜力的


  Jan. 25, 2005 - 根据一项发表于2月号放射学期刊的试验结果,核磁共振造影(MRI)对于评估右下腹疼痛的怀孕妇女,是一种有潜力的装置。
  
  德州大学盖维斯顿医学分校Aytekin Oto医师与其同事表示,优异的软组织对比分辨率,与多平面显像能力,且不需要非离子对比剂,使得MRI成为使用于怀孕妇女有潜力的装置;MRI可以呈现怀孕时看到的骨盆团块,及作为产后并发症与怀孕妇女之许多紧急状况的诊断工具;就我们所知,目前还没有有关于使用MRI诊断怀孕妇女急性盲肠炎的文献。
  
  研究人员回溯性分析以1.5-T核磁共振影像装置所获得的影像,以及23位以急性右下腹疼痛表现之怀孕妇女的就医纪录,年龄介于19至34岁之间(平均年龄为24.7岁)。
  
  MR计划包括于下腹部与骨盆位置执行的,横轴的、冠状的、矢壮轴的非连续T2加权单射快速环绕音波(SE)程序;横轴压抑脂肪讯号的T2加权快速SE程序;横轴T1加权梯度回复音波程序;以及横轴、冠状短程反向时间反向回复程序;由2位放射科医师评估MR结果,以及与外科及病理发现、临床追踪数据比较。
  
  23位病患中,有20位病患的盲肠是可以看见的(86.9%),14位病患接受内科治疗,7位接受外科手术的病患中,4位患有急性盲肠炎,3位是卵巢翻转,2位非盲肠炎造成的骨盆囊肿病患接受外科引流手术。
  
  4位急性盲肠炎患者中,有3位(75%)是扩张的、厚壁的盲肠,而且有盲肠周围的发炎;1位盲肠炎病患的盲肠在MRI上无法目测,但是在右下腹有发炎现象。
  
  3位卵巢翻转的病患中,MRI显示有一个右侧肾上腺团块、或是发炎;有2位病患,MRI正确地确认出骨盆囊肿,以及健康的盲肠;MRI可以区分出19位没有急性盲肠炎受试者中,有17位(89.5%)的盲肠是健康的。
  
  研究人员表示,MRI对于透过协助右下腹疼痛其它可能原因的诊断,包括卵巢翻转、与骨盆囊肿,对于怀疑患有急性盲肠炎的怀孕妇女来说是很有潜力的,而且可以区分出健康的盲肠;而它的另一项好处是,能够区分出没有急性盲肠炎的健康盲肠,这可免除病患接受不必要的盲肠切除术。
  
  该项试验的限制因素,包括回溯性分析、缺乏有关使用或是未使用超音波检验的资料、后续追踪不完全、以及样本数太小。
  
  研究人员附带表示,超音波检验可能是急性腹部疼痛怀孕妇女的首选检验方式,特别是在怀孕第1期时;不过,除非是绝对需要的情况下,否则于怀孕第1期时,并不建议使用MRI。

MRI Shows Promise for Evaluati

By Laurie Barclay, MD
Medscape Medical News

Jan. 25, 2005 — Magnetic resonance imaging (MRI) is a promising modality for evaluating pregnant women with right-lower-quadrant pain, according to the results of a study published in the February issue of Radiology.

"Excellent soft-tissue contrast resolution and multiplanar imaging capability, in combination with lack of ionizing radiation, make MR imaging a promising modality for use in pregnant women," write Aytekin Oto, MD, from the University of Texas Medical Branch at Galveston, and colleagues. "MR imaging allows characterization of pelvic masses discovered during pregnancy and diagnosis of postpartum complications and various acute conditions in pregnant women. To our knowledge, no data exist in the literature about the use of MR imaging in the diagnosis of acute appendicitis in pregnant women."

The authors retrospectively reviewed images obtained with a 1.5-T MR imager and medical records of 23 pregnant women who presented with acute right-lower-quadrant pain. Age range was 19 to 34 years (mean, 24.7 years).

The MR protocol involved transverse, coronal, and sagittal noncontiguous T2-weighted single-shot fast spin-echo (SE) sequences; transverse fat-suppressed T2-weighted fast SE sequences; transverse T1-weighted gradient-recalled-echo sequences; and transverse and coronal short inversion time inversion-recovery sequences performed through the lower abdomen and pelvis. Two radiologists evaluated MR findings and compared them with surgical and pathologic findings and clinical follow-up data.

The appendix could be visualized in 20 (86.9%) of 23 patients. Fourteen patients were treated medically. Of seven patients who underwent surgery; four had acute appendicitis, and three had ovarian torsion. Two patients with pelvic abscesses not caused by appendicitis underwent percutaneous drainage.

Of four patients with acute appendicitis, three (75%) had a dilated thick-walled appendix and periappendiceal inflammation. One patient with appendicitis in whom the appendix could not be visualized had inflammation in the right lower quadrant.

In the three patients with ovarian torsion, MRI revealed a right adnexal mass or inflammation. In two patients, MRI correctly identified pelvic abscesses and a healthy appendix. MRI revealed a healthy appendix in 17 (89.5%) of 19 patients without acute appendicitis.

"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 unhealthy appendix," the authors write. "Visualization of the normal appendix in patients without acute appendicitis is another important advantage that may save patients from undergoing unnecessary appendectomy."

Study limitations include retrospective design, lack of information about the presence or absence of ultrasound examinations, incomplete follow-up, and small sample size.

The authors caution that ultrasound is probably the imaging modality of choice in pregnant women with acute abdominal pain, especially in the first trimester. "During the first trimester, MR imaging is not recommended, unless it is absolutely clinically necessary," they write.

The authors report no potential financial conflicts of interest.

Radiology. 2005;234:445-451

Reviewed by Gary D. Vogin, MD

    
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