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Figure 2b. Usefulness of oral contrast material and TOF imaging in evaluation of the normal appendix during pregnancy in a 31-year-old woman who was 30 weeks pregnant and had RLQ pain and nausea. (a) Axial T2-weighted single-shot fast SE image of the gravid abdomen shows the cecum (C) and terminal ileum (*). A possible normal appendix (arrow) is seen posterior to the cecum. However, other tubular hypointense structures (arrowheads) with a similar appearance are seen medial to the psoas muscle. (b) Axial TOF GRE image obtained at the same level shows the characteristic enlargement and decreased signal intensity of the appendix (arrow), the so-called blooming effect, which is caused by the susceptibility effect of air or the iron-based oral contrast medium within its lumen. Note the same effect in the cecum (C) and terminal ileum (*). This phenomenon virtually excludes appendicitis. TOF images are also essential in differentiating the common periovarian varices (arrowheads) with very high signal intensity from the hypointense appendix; this distinction cannot be made on the single-shot fast SE images alone.
