DIAGNOSTIC ACCURACY OF MAGNETIC RESONANCE IMAGING VERSUS COMPUTED TOMOGRAPHY IN EVALUATION OF ACUTE APPENDICITIS: A CROSS-SECTIONAL STUDY
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Keywords
Acute appendicitis, Magnetic resonance imaging, Computed tomography, Diagnostic accuracy, Radiation-free imaging
Abstract
Introduction: Acute appendicitis represents the most common surgical emergency, with diagnostic challenges leading to high misdiagnosis rates and unnecessary surgeries. While computed tomography has become the imaging gold standard, radiation exposure concerns have prompted investigation of magnetic resonance imaging as a viable alternative. This study aimed to compare the diagnostic accuracy of MRI versus CT in evaluating suspected acute appendicitis.
Methods: A prospective cross-sectional study was conducted at Santosh Medical College & Hospital, Ghaziabad, from July-December 2012. One hundred seventy-five patients aged 16-65 years with clinically suspected appendicitis underwent both contrast-enhanced CT and MRI examinations within six hours. Blinded radiologists interpreted images using standardized protocols. Final diagnosis was established through surgical findings, histopathological examination, or clinical follow-up.
Results: Of 175 patients, 108 (61.7%) had confirmed appendicitis. CT achieved sensitivity of 96.3%, specificity of 88.1%, and overall accuracy of 93.1%. MRI demonstrated sensitivity of 93.5%, specificity of 91.0%, and overall accuracy of 92.6%. No statistically significant differences existed between modalities across all performance metrics (p>0.05). ROC analysis revealed comparable diagnostic performance with area under curve of 0.923 for CT and 0.924 for MRI (p=0.971). Both modalities successfully identified alternative diagnoses in 38.3% of patients without appendicitis. Inter-modality agreement was substantial (Cohen's kappa=0.774).
Conclusion: MRI demonstrates diagnostic accuracy equivalent to CT for acute appendicitis evaluation, supporting its implementation as a radiation-free alternative imaging modality, particularly beneficial for younger patients and those requiring repeat examinations.
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Sanjay Nathani
Assistant Professor, Department of Radiology, Santosh Medical College & Hospital, Ghaziabad, NCR-Delhi.