Can Diffusion-Weighted Imaging be a Gold Standard Method for Acute Appendicitis? A Comparative Study

Abstract

Background: Diagnosis of an inflamed appendix is commonly based on clinical, laboratory, and diagnostic imaging data. Ultrasonography (US) is the leading diagnostic modality for these patients. However, an inconclusive US examination suggests the application of non-enhanced computed tomography (NECT). Objectives: This study aimed to compare US, NECT, and diffusion-weighted magnetic resonance imaging (DW-MRI) examinations for an accurate diagnosis of acute appendicitis with the rate of proven appendicitis by surgery. Patients and Methods: This retrospective study was performed on 70 patients, diagnosed with acute appendicitis between February 2018 and January 2020. The diagnostic accuracy of US, CT, and DW-MRI for acute appendicitis was examined in relation to the demographic and clinical variables. Results: Age and gender were not significantly associated with surgically proven appendicitis. However, the appendix diameter had a significant association with surgically proven appendicitis. All DW-MRI–positive patients with acute abdominal symptoms were surgically diagnosed with acute/subacute appendicitis (even those with < 6 mm in diameter). Based on the ROC curve analysis, the sensitivity and specificity of DW-MRI in predicting acute appendicitis was 100% and 90.90%, respectively. Conclusion: The appendix diameter was an important factor in diagnosing acute appendicitis. However, DW-MRI is an advanced technique that may exclude the need for the appendix diameter measurements.