Contribution of diffusion-weighted MR imaging in follow-up of inflammatory appendiceal mass: Preliminary results and review of the literature Oğuzhan.

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Contribution of diffusion-weighted MR imaging in follow-up of inflammatory appendiceal mass: Preliminary results and review of the literature Oğuzhan Özdemir, MD, Yavuz Metin, MD, Nurgül Orhan Metin, MD, Ali Küpeli, MD, Süleyman Kalcan, Filiz Taşçı European Journal of Radiology Open Volume 3, Pages 207-215 (January 2016) DOI: 10.1016/j.ejro.2016.08.005 Copyright © 2016 The Author(s) Terms and Conditions

Fig. 1 Patient flow diagram. European Journal of Radiology Open 2016 3, 207-215DOI: (10.1016/j.ejro.2016.08.005) Copyright © 2016 The Author(s) Terms and Conditions

Fig. 2 A 48-year-old male with acute right lower quadrant (RLQ) pain for 4days. Clinical, laboratory and imaging findings suggested IAM. The patient underwent interval appendectomy at the fourth week of follow-up. (a) CT at presentation shows a RLQ mass (IAM) bordered by cecum laterally, ileum anteriorly and gerota fascia posteriorly (arrow). (b, c) DWI (b=1000) and ADC map at presentation show restricted diffusion (arrow). (d, e) Four weeks after initial presentation, DWI (b=1000) and ADC map reveal total recovery at the localization of previous IAM, both qualitatively and quantitatively. (f) Microscopy of appendectomy specimen shows no any inflammatory cells. European Journal of Radiology Open 2016 3, 207-215DOI: (10.1016/j.ejro.2016.08.005) Copyright © 2016 The Author(s) Terms and Conditions

Fig. 3 Graphs show the correlation between (a) CRP and ADC values, (b) WBC and ADC values, (c) IAMdim and ADC values. European Journal of Radiology Open 2016 3, 207-215DOI: (10.1016/j.ejro.2016.08.005) Copyright © 2016 The Author(s) Terms and Conditions

Fig. 4 Graphs show the change of (a) IAM dimension, (b) ADC mean, (c) CRP mean, (d) WBC mean. European Journal of Radiology Open 2016 3, 207-215DOI: (10.1016/j.ejro.2016.08.005) Copyright © 2016 The Author(s) Terms and Conditions

Fig. 5 A 54-year-old male with right lower quadrant (RLQ) pain for last 5days. Clinical, laboratory and imaging findings were suggestive of IAM at presentation. Although there was relief of pain and improvement of laboratory tests following two weeks antibiotik therapy, on control DWI there was not any change of the RLQ mass (not shown in the figure). Colonoscopy performed at second week of follow-up showed a cecal mass. Surgery revealed cecal adenocancer with appendiceal mucocele. (a) CT at presentation shows a complex RLQ inflammatory mass (arrows). (b, c) DWI (b=500) and ADC map at presentation show restricted diffusion of the mass (arrows). European Journal of Radiology Open 2016 3, 207-215DOI: (10.1016/j.ejro.2016.08.005) Copyright © 2016 The Author(s) Terms and Conditions

Fig. 6 A 37-year-old female with right lower quadrant (RLQ) pain for last 3days. Clinical, laboratory and imaging findings were suggestive of IAM at presentation. At the sixth moth of follow-up the patient came over with RLQ pain suggestive of relapse of appendicitis. Imaging findings were compatible with IAM. (a, b) DWI and ADC map reveal a RLQ mass with diffusion restriction at the time of first presenation (arrows). (c, d) Control DWI and ADC map show complete regression of IAM with antibiotic therapy. (e, f) Six months following the first presentation there was recurrence of IAM depicted on DWI and ADC map (arrows). European Journal of Radiology Open 2016 3, 207-215DOI: (10.1016/j.ejro.2016.08.005) Copyright © 2016 The Author(s) Terms and Conditions