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目的将剖腹手术阴性率(NLR)和穿孔率(PR)作为衡量标准,明确右下腹疼痛孕妇采用整合MR成像的临床检查是否能获得更好的结果。材料与方法这项回顾性研究获得了机构审查委员会的批准。收录了从1996年1月1日至2011年8月31日,已进行手术治疗(n=82)或MRI检查(n=217)的共267例疑似阑尾炎的孕妇病人。相关超声和MRI结果被分类为真阳性、假阳性、真阴性、假阴性或结果不确定。根据MRI的应用情况,将病人分为应用MRI前和应用MRI后两个组别。两个组别分别计算NLR和PR,并采用Fisher精确概率检验进行统计分析,计算出MRI的敏感度、特异度、阳性预测值(PPV)、阴性预测值(NPV)。结果 MRI于2004年应用于临床诊断检查。从1996年—2003年,疑似阑尾炎的孕妇的NLR为55%(17/35),PR为21%(3/14)。从2004年—2011年,NLR是29%(15/51),PR为26%(9/35)。NLR下降47%[(55%~29%)/55%],并有统计学意义(P=0.02)。PR的变化无统计学意义(P>0.99)。MRI诊断阑尾炎的敏感度、特异度、PPV和NPV分别为89%(17/19)、97%(187/193)、74%(17/23)、99%(187/189)。结论在本中心,将MRI检查列入疑似阑尾炎的孕妇的常规检查中能够降低47%的剖腹手术阴性率,而阑尾穿孔率没有显著变化。
Objectives To assess whether NLR and PR can be used as a criterion to determine whether clinical results of integrated MR imaging in pregnant women with right lower quadrant pain can achieve better results. Materials and Methods This retrospective study was approved by the Institutional Review Board. A total of 267 pregnant women with suspected appendicitis who underwent surgery (n = 82) or MRI (n = 217) from January 1, 1996 to August 31, 2011 were included. Related ultrasound and MRI findings are classified as true positive, false positive, true negative, false negative, or indeterminate. According to the application of MRI, the patients were divided into two groups before applying MRI and applying MRI. NLR and PR were calculated respectively in the two groups, and Fisher’s exact test was used for statistical analysis to calculate the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of MRI. Results MRI in 2004 for clinical diagnosis. From 1996 to 2003, pregnant women with suspected appendicitis had an NLR of 55% (17/35) and a PR of 21% (3/14). From 2004 to 2011, NLR was 29% (15/51) and PR was 26% (9/35). The NLR decreased 47% [(55% -29%) / 55%], and was statistically significant (P = 0.02). The change of PR was not statistically significant (P> 0.99). The sensitivity, specificity, PPV and NPV of MRI in the diagnosis of appendicitis were 89% (17/19), 97% (187/193), 74% (17/23) and 99% (187/189) respectively. Conclusions Our routine examination of MRI screening for pregnant women with suspected appendicitis reduced the negative rate of laparotomy by 47% without any significant change in the perforation rate of the appendix.