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Rapid MR examination with deep learning reconstruction improves diagnosis of complicated acute appendicitis
Jing-Juan Liu1, Chen Lin2, Wei Liu1
1Department of Radiology, Peking Union Medical College Hospital, China.
Objective:
To evaluate the performance of a non-contrast rapid magnetic resonance imaging (MRI) protocol with deep learning reconstruction (DLR) for identifying complicated appendicitis in patients with acute appendicitis, compared to conventional MRI without DLR (non-DLR) and non-contrast computed tomography (NC-CT).
Methods:
Sixty-two eligible patients were enrolled, of which 55 had a final diagnosis of acute appendicitis and were included for further analysis of complications. Among them, 51 underwent both NC-CT and MRI, while 4 pregnant patients underwent MRI only. The MRI protocol included T2-weighted imaging (with and without fat suppression), T1-weighted imaging, and diffusion-weighted imaging (DWI). Two abdominal radiologists independently evaluated the subjective and objective image quality of DLR and non-DLR images using a 5-point Likert scale to assess diagnostic confidence for complicated appendicitis. Interobserver agreement (kappa statistics) and receiver operating characteristic (ROC) analysis were performed.
Results:
MRI with DLR demonstrated significantly better objective and subjective image quality than non-DLR MRI, with improved appendix delineation and reduced noise (p < 0.01). With a mean acquisition time of 9.5 min, both MRI protocols outperformed NC-CT in the diagnosis of complicated appendicitis (p = 0.035 andp = 0.001, respectively). MRI-DLR achieved higher sensitivity (97.06 % vs. 88.24 %) and negative predictive value (95.45 % vs. 84.00 %) for complicated appendicitis than MRI-non-DLR. The detection rates of appendiceal wall discontinuity and peri-appendiceal abscesses were significantly higher with MRI-DLR (p < 0.05).
Conclusion:
Rapid MRI with DLR improves image quality and diagnostic accuracy for complicated appendicitis compared to non-DLR MRI and NC-CT, offering a valuable alternative for radiation-sensitive patients.
Insights
Deep learning reconstruction (DLR) enhanced rapid MRI significantly improves image quality and accuracy for diagnosing complicated appendicitis compared to standard MRI and CT scans. This advanced MRI technique offers a radiation-free alternative for patients requiring appendicitis evaluation.
Area of Science:
- Radiology
- Medical Imaging
- Artificial Intelligence in Medicine
Background:
- Acute appendicitis is a common surgical emergency.
- Diagnosing complicated appendicitis requires accurate imaging to guide treatment.
- Non-contrast computed tomography (NC-CT) is widely used but involves radiation exposure.
- Magnetic resonance imaging (MRI) offers a radiation-free alternative, but conventional protocols can be time-consuming.
Purpose of the Study:
- To evaluate a rapid, non-contrast MRI protocol utilizing deep learning reconstruction (DLR) for identifying complicated appendicitis.
- To compare the performance of DLR-enhanced MRI against conventional MRI (non-DLR) and NC-CT.
Main Methods:
- A prospective study included 62 patients with suspected acute appendicitis.
- MRI protocols (T2-weighted, T1-weighted, DWI) with and without DLR were performed.
- Two radiologists assessed image quality and diagnostic confidence for complicated appendicitis.
- Receiver operating characteristic (ROC) analysis was used to compare diagnostic performance.
Main Results:
- MRI with DLR showed significantly superior objective and subjective image quality, with better appendix visualization and reduced noise compared to non-DLR MRI (p < 0.01).
- Both MRI protocols outperformed NC-CT in diagnosing complicated appendicitis (p = 0.035 and p = 0.001).
- MRI-DLR achieved higher sensitivity (97.06%) and negative predictive value (95.45%) for complicated appendicitis than MRI-non-DLR.
- Detection rates for appendiceal wall discontinuity and peri-appendiceal abscesses were significantly higher with MRI-DLR (p < 0.05).
Conclusions:
- Rapid MRI with DLR enhances image quality and diagnostic accuracy for complicated appendicitis.
- This DLR-enhanced MRI protocol is a valuable, radiation-free alternative to NC-CT, particularly for radiation-sensitive populations.
