Is magnetic resonance imaging a viable alternative to ultrasound as the primary imaging modality in the diagnosis of paediatric appendicitis? A systematic review

Abstract

yesBackground: Appendicitis is the most common cause of acute abdominal pain requiring surgical intervention\ud in paediatric patients. Ultrasound is generally the diagnostic imaging modality of choice, followed\ud by CT, where paediatric appendicitis is suspected. However, high operator dependency and\ud diagnostic restrictions related to anatomical and clinical presentation may limit consistency of application.\ud This paper explores whether MRI is a viable alternative to ultrasound as the primary imaging\ud modality.\ud Method: A systematic review of the literature was undertaken. A search of Medline, Cinahl, PubMed\ud Central and Google Scholar was undertaken supplemented by a review of reference lists, author\ud searching and review of NICE evidence base for existing guidelines. Included studies were assessed for\ud bias using the QUADAS-2 quality assessment tool and data were extracted systematically using a purposefully\ud designed electronic data extraction proforma.\ud Results: Seven studies were included in final review. The age range of participants extended from 0 to 19\ud years. Only one study with a patient age range of 0e14 used sedation. Sensitivity estimates from the\ud included studies ranged from 92% to 100% while specificity ranged from 89% to 100%. A significant\ud variation in the number and type of sequences was noted between the studies.\ud Conclusion: MRI offers high sensitivity and specificity comparable to contrast enhanced CT and greater\ud than ultrasound as reported in the literature. Where accessibility is not a restriction, MRI is a viable\ud alternative to ultrasound in the assessment and diagnosis of paediatric appendicitis. Clinical practice\ud recommendations have been provided to facilitate the translation of evidence into practice.Funding info requested 17/03/201

Magnetic Resonance Imaging Provides Useful Diagnostic Information Following Equivocal Ultrasound in Children With Suspected Appendicitis

“…Generalizability may also be limited as individuals presenting to our center outside of office hours were excluded (in keeping with regular MRI technician availability at our site); however, our participant demographics are consistent with most other appendicitis cohorts, and there is no reason to suspect different performance of MRI outside of research office hours. We did not include children under 5 years due to concerns of MRI tolerance, as this population may experience difficulty with imaging studies without sedation (21). Our study included a modest sample of individuals who received an MRI (N ¼ 101) and individuals with confirmed appendicitis (n ¼ 39), which is within the range of other MRI study sample sizes (N ¼ 42-208) (21), and our findings are consistent with other studies.…”

“…We did not include children under 5 years due to concerns of MRI tolerance, as this population may experience difficulty with imaging studies without sedation (21). Our study included a modest sample of individuals who received an MRI (N ¼ 101) and individuals with confirmed appendicitis (n ¼ 39), which is within the range of other MRI study sample sizes (N ¼ 42-208) (21), and our findings are consistent with other studies. Additionally, we performed MRI using a 1.5 T scanner, as it was clinically available and is most readily available in Canada.…”

“…However, increases in the availability and accessibility of MRI, faster effective sequencing techniques, and diagnostic accuracy could improve its use. 20,21 Although MRI has been offered as an optimal secondary imaging modality following equivocal US 14,18,22,23 and considered a viable primary imaging modality in locations with 24-hour access, 24 it is infrequently utilized for pediatric appendicitis in Canada. 5 The primary purpose of this study was to identify the proportion of children with initial equivocal US studies in whom MRI determined a positive or negative result.…”

Student Perspectives of the Effective Behaviors of Occupational Therapy Level II Fieldwork Educators

“…Similarly, Ludin and Fathullah (2016) found the teaching skills of encouraging participation, the ability to prompt discussion through learning, and communicate expectations as having a positive influence on student learning. Scaffolding learning experiences tailored to student knowledge and skills is indicative of a quality fieldwork experience (Francis et al, 2016;Grenier, 2015).…”