Tomoelastography for non-invasive detection and treatment monitoring in acute appendicitis

BMJ Case Rep. 2019 Aug 26;12(8):e230791. doi: 10.1136/bcr-2019-230791.


Acute appendicitis is the most common cause of the acute abdomen syndrome and can be treated either surgically or conservatively with antibiotics. This case demonstrates the first time use of mechanics based MRI by tomoelastography with generation of quantitative maps of tissue stiffness (shear wave speed in m/s) and tissue fluidity (shear modulus loss angle, in rad) in a case of uncomplicated acute appendicitis with antibiotic treatment at (i) baseline, (ii) the end of treatment (EOT) and (iii) the 10 day follow-up after EOT. Baseline maps of stiffness and fluidity revealed to the naked eye the extent of intestinal inflammation by markedly increased values of stiffness and fluidity (2.56±0.12 m/s, 1.37±0.24 rad) compared with normal values, indicating the immediate response to antibiotic treatment at EOT (1.47±0.28 m/s, 0.80±0.11 rad) and persistent normalisation at follow-up (1.54±0.22 m/s, 0.92±0.22 rad). Tomoelastography is a non-invasive, quantitative imaging method for mechanics based characterisation and follow-up of acute appendicitis.

Keywords: drug therapy related to surgery; drugs: gastrointestinal system; infection (gastroenterology); radiology.

Publication types

  • Case Reports
  • Video-Audio Media

MeSH terms

  • Abdominal Pain / diagnosis*
  • Abdominal Pain / etiology
  • Adult
  • Anti-Bacterial Agents / administration & dosage
  • Appendicitis* / diagnosis
  • Appendicitis* / physiopathology
  • Appendicitis* / therapy
  • Appendix / diagnostic imaging*
  • Comparative Effectiveness Research
  • Conservative Treatment / methods
  • Elasticity Imaging Techniques / methods*
  • Humans
  • Magnetic Resonance Imaging / methods*
  • Male
  • Patient Selection
  • Reproducibility of Results
  • Treatment Outcome
  • Ultrasonography / methods


  • Anti-Bacterial Agents