Contribution of Diffusion-Weighted Magnetic Resonance Imaging in the Follow-Up of Uncomplicated Acute Appendicitis: Initial Results

Several studies have shown that the majority of patients with simple appendicitis can be treated effectively and safely with antibiotics, avoiding unnecessary operation.
The objective of this study was to assess the role of diffusion-weighted imaging (DWI) in the follow-up of conservative treatment of simple appendicitis.
Patients and Twenty-eight patients (mean age, 35 ± 14.6; age range, 18 - 72; M/F: 16/12) with simple appendicitis were enrolled in this prospective study. After the primary diagnosis by computed tomography (CT) at presentation, they underwent an initial DWI scan, and intravenous antibiotic therapy was started for all patients by the decision of the attending surgeon. A total of three control DWI scans were planned during the follow-up period for each patient. CT and DWI images were evaluated by two radiologists in consensus. B values 0, 500 and 1000 s/mm2 were used, and DWI images were analyzed both qualitatively and quantitatively. During follow-up, changes in the diameter of appendices and laboratory parameters were correlated with apparent diffusion coefficient (ADC) values.
We found statistically significant correlation between ADC values, maximum appendix diameter and laboratory parameters. During follow-up period four surgical procedures were performed for reccurent appendicitis.
DWI may be used with a significant success for follow-up evaluation of patients with simple appendicitis. As a monitoring imaging method, DWI may also aid in determining the recurrences of appendicitis.