Diagnostic Accuracy of MRI Versus CT for the Evaluation of Acute Appendicitis in Children and Young Adults

Kinner, Sonja; Pickhardt, Perry J.; Riedesel, Erica L.; Gill, Kara G.; Robbins, Jessica B.; Kitchin, Douglas R.; Ziemlewicz, Timothy J.; Harringa, John B.; Reeder, Scott B.; Repplinger, Michael D.

doi:10.2214/ajr.16.17413

Cited by 45 publications

(14 citation statements)

References 22 publications

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“…only to patients aged 12 years or older to minimize the need for sedation. It should be noted, however, that we recently published an analysis of the test accuracy of our MR imaging protocol in patients younger than 21 years (28). Those patients were also included in this study cohort, although that analysis also included the interpretations of three pediatric radiologists.…”

Section: Figurementioning

confidence: 99%

Prospective Comparison of the Diagnostic Accuracy of MR Imaging versus CT for Acute Appendicitis

et al. 2018

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Purpose To compare the accuracy of magnetic resonance (MR) imaging with that of computed tomography (CT) for the diagnosis of acute appendicitis in emergency department (ED) patients. Materials and Methods This was an institutional review board-approved, prospective, observational study of ED patients at an academic medical center (February 2012 to August 2014). Eligible patients were nonpregnant and 12- year-old or older patients in whom a CT study had been ordered for evaluation for appendicitis. After informed consent was obtained, CT and MR imaging (with non-contrast material-enhanced, diffusion-weighted, and intravenous contrast-enhanced sequences) were performed in tandem, and the images were subsequently retrospectively interpreted in random order by three abdominal radiologists who were blinded to the patients' clinical outcomes. Likelihood of appendicitis was rated on a five-point scale for both CT and MR imaging. A composite reference standard of surgical and histopathologic results and clinical follow-up was used, arbitrated by an expert panel of three investigators. Test characteristics were calculated and reported as point estimates with 95% confidence intervals (CIs). Results Analysis included images of 198 patients (114 women [58%]; mean age, 31.6 years ± 14.2 [range, 12-81 years]; prevalence of appendicitis, 32.3%). The sensitivity and specificity were 96.9% (95% CI: 88.2%, 99.5%) and 81.3% (95% CI: 73.5%, 87.3%) for MR imaging and 98.4% (95% CI: 90.5%, 99.9%) and 89.6% (95% CI: 82.8%, 94.0%) for CT, respectively, when a cutoff point of 3 or higher was used. The positive and negative likelihood ratios were 5.2 (95% CI: 3.7, 7.7) and 0.04 (95% CI: 0, 0.11) for MR imaging and 9.4 (95% CI: 5.9, 16.4) and 0.02 (95% CI: 0.00, 0.06) for CT, respectively. Receiver operating characteristic curve analysis demonstrated that the optimal cutoff point to maximize accuracy was 4 or higher, at which point there was no difference between MR imaging and CT. Conclusion The diagnostic accuracy of MR imaging was similar to that of CT for the diagnosis of acute appendicitis.

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Section: Figurementioning

confidence: 99%

Prospective Comparison of the Diagnostic Accuracy of MR Imaging versus CT for Acute Appendicitis

et al. 2018

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“…The healthy appendix on CT imaging appears as thin-walled tubular or annular structure wrapped by the mesenteric fat in the right lower abdomen with the diameter generally <6 mm. Imaging findings associated with appendicitis have been widely documented in the literature 9 20–23. The CT diagnosis of LAMNs with rupture is relatively straightforward when complex peritoneal diseases and a dilated and ruptured appendiceal mucinous neoplasm are identified in the right lower quadrant 15 24.…”

Section: Discussionmentioning

confidence: 99%

Low-Grade Appendiceal Mucinous Neoplasms Confined to the Appendix: Clinical Manifestations and CT Findings

Murai

Tang

et al. 2020

Journal of Investigative Medicine

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The clinical findings and CT images are investigated in order to fulfill an early preoperative diagnosis and increase awareness of low-grade appendiceal mucinous neoplasm (LAMN) confined to the appendix. 17 cases with histologically proven LAMNs confined to the appendix were included in this study. All patients had received multiphase CT examinations before the surgery. The imaging criteria included shape, size, margin, attenuation, secondary degeneration and internal mass enhancement pattern. In CT images, all cases appeared as oval or tubular cystic masses (average attenuation 20.4±3.6 Hounsfield units), with the longest dimensions ranging from approximately 38 to 106 mm (mean 66.3 mm), and the ratio of length against width was 1.83 in average. The cystic wall was unevenly thickened, with a mean maximal wall thickness of 5.7 mm (>10 mm in 3 cases). The inner capsule wall was rough, and calcification was observed in 3 cases. A few amounts of periappendiceal fat stranding were noted in 2 cases. Mild ring mural enhancement of the cystic wall was seen during the arterial phase, with progressive enhancement during the portal venous phase. In addition, mini enhancing mural nodules was observed in 5 cases. Although preoperative diagnosis of LAMNs confined to the appendix remains challenging, it should be considered when a focal well-defined cystic mass with slightly higher than water attenuation, thickened cystic wall with ring mural enhancement and a characteristic progressive contrast enhancement in CT imaging, especially in older females with non-specific symptoms similar to appendicitis.

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“…Several recent publications have reported the accuracy of MRI specifically for the diagnosis of appendicitis . However, because nonappendiceal pathologies have a higher prevalence than appendicitis among patients undergoing CT for possible appendicitis, understanding the performance of MRI as it pertains to these alternative diagnoses is imperative.…”

Section: Discussionmentioning

confidence: 99%

“…Several recent publications have reported the accuracy of MRI specifically for the diagnosis of appendicitis. 9,[12][13][14] However, because nonappendiceal pathologies have a higher prevalence than appendicitis among patients undergoing CT for possible appendicitis, 8 understanding the performance of MRI as it pertains to these alternative diagnoses is imperative. In this study, we present the sensitivity of both NCE-MR and CE-MR for alternative diagnoses observed in those patents undergoing imaging due to clinical suspicion of appendicitis.…”

Section: Discussionmentioning

confidence: 99%

Prospective evaluation of MRI compared with CT for the etiology of abdominal pain in emergency department patients with concern for appendicitis

Harringa

Bracken

Davis

et al. 2019

Magnetic Resonance Imaging

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Background Computed tomography (CT) is commonly used in the Emergency Department (ED) to evaluate patients with abdominal pain, but exposes them to ionizing radiation, a possible carcinogen. MRI does not utilize ionizing radiation and may be an alternative. Purpose To compare the sensitivity of MRI and CT for acute abdominopelvic ED diagnoses. Study Type Prospective, observational cohort. Population ED patients ≥12 years old and undergoing CT for possible appendicitis. Field Strength/Sequence 1.5 T MRI, including T1‐weighted, T2‐weighted, and diffusion‐weighted imaging sequences. Assessment Three radiologists independently interpreted each MRI and CT image set separately and blindly, using a standard case report form. Assessments included likelihood of appendicitis, presence of an alternative diagnosis, and likelihood that the alternative diagnosis was causing the patient's symptoms. An expert panel utilized chart review and follow‐up phone interviews to determine all final diagnoses. Times to complete image acquisition and image interpretation were also calculated. Statistical Tests Sensitivity was calculated for each radiologist and by consensus (≥2 radiologists in agreement) and are reported as point estimates with 95% confidence intervals. Two‐sided hypothesis tests comparing the sensitivities of the three image types were conducted using Pearson's chi‐squared test with the traditional significance level of P = 0.05. Results There were 15 different acute diagnoses identified on the CT/MR images of 113 patients. Using individual radiologist interpretations, the sensitivities of noncontrast‐enhanced MRI (NCE‐MR), contrast‐enhanced MR (CE‐MR), and CT for any acute diagnosis were 77.0% (72.6–81.4%), 84.2% (80.4–88.0%), and 88.7% (85.5–92.1%). Sensitivity of consensus reads was 82.0% (74.9–88.9%), 87.1% (81.0–93.2%), 92.2% (87.3–97.1%), respectively. There was no difference in sensitivities between CE‐MR and CT by individual (P = 0.096) or consensus interpretations (P = 0.281), although NCE‐MR was inferior to CT in both modes of analysis (P < 0.001, P = 0.031, respectively). Data Conclusion The sensitivity of CE‐MR was similar to CT when diagnosing acute, nontraumatic abdominopelvic pathology in our cohort. Level of Evidence: 2 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;50:1651–1658.

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Diagnostic Accuracy of MRI Versus CT for the Evaluation of Acute Appendicitis in Children and Young Adults

Cited by 45 publications

References 22 publications

Prospective Comparison of the Diagnostic Accuracy of MR Imaging versus CT for Acute Appendicitis

Prospective Comparison of the Diagnostic Accuracy of MR Imaging versus CT for Acute Appendicitis

Low-Grade Appendiceal Mucinous Neoplasms Confined to the Appendix: Clinical Manifestations and CT Findings

Prospective evaluation of MRI compared with CT for the etiology of abdominal pain in emergency department patients with concern for appendicitis

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