Radiology
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

Published online before print August 18, 2008, 10.1148/radiol.2483080066
This Article
Right arrow Figures Only
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow All Versions of this Article:
2483080066v1
249/1/134    most recent
Right arrow Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Lee, K. S.
Right arrow Articles by Pedrosa, I.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Lee, K. S.
Right arrow Articles by Pedrosa, I.
(Radiology 2008;249:134-141.)
© RSNA, 2008

Gastrointestinal Imaging

Localization of the Appendix at MR Imaging during Pregnancy: Utility of the Cecal Tilt Angle1

Karen S. Lee, MD, Neil M. Rofsky, MD, and Ivan Pedrosa, MD

1 From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215. Received January 10, 2008; revision requested February 23; final revision received March 4; accepted March 12; final version accepted March 28. Address correspondence to I.P. (e-mail: ipedrosa{at}bidmc.harvard.edu).

Purpose: To determine whether the cecal tilt angle on sagittal magnetic resonance (MR) images in pregnant patients correlates with the location of the appendix and gestational age and whether the cecal tilt angle can help predict the location of the appendix.

Materials and Methods: This HIPAA-compliant retrospective study was approved by the institutional review board. Informed consent was waived. Of 146 consecutive pregnant patients suspected of having appendicitis (mean age, 29 years) who underwent MR imaging, 143 had MR images in which the appendix and cecum were identifiable in the sagittal plane. Two observers reviewed the MR images; findings were agreed upon by consensus. With use of sagittal single-shot fast spin-echo MR images, the cecal tilt angle was calculated as the angle between the imaging table and a line drawn between the cecal tip and the luminal center of the most proximal inflection point in the ascending colon. The location of the appendiceal base relative to the lumbosacral spine was recorded. Statistical analyses were performed by using Spearman and Pearson correlation coefficients to evaluate the relationship among gestational age, appendiceal base location, and cecal tilt angle. Receiver operating characteristic curve analysis was performed to assess the ability of the cecal tilt angle to help differentiate between a high and low appendiceal base level.

Results: Cecal tilt angles showed moderate correlation with appendiceal base levels (Spearman correlation coefficient, 0.44; P < .001) and poor correlation with gestational age (Pearson correlation coefficient, 0.25; P = .002). Regardless of gestational age, cecal tilt angles of at least 90° were predictive of a high appendiceal base level with a specificity of 98% (95% confidence interval: 92%, 100%).

Conclusion: The cecal tilt angle is useful for localizing the appendix in pregnant patients at MR imaging and helps predict the location of the appendix within the right upper quadrant of the abdomen with high specificity, irrespective of gestational age.

© RSNA, 2008