MR imaging in children with nonperforated acute appendicitis: value of unenhanced MR imaging in sonographically selected cases.

Hörmann, Marcus; Paya, Kurosh; Eibenberger, K.; Dorffner, Roland; Lang, S.; Kreuzer, Sören; Metz, V.

doi:10.2214/ajr.171.2.9694477

Cited by 106 publications

(49 citation statements)

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“…MRI has been reported to obtain good results for excluding or detecting appendicitis [13][14][15][16][17]19]. Our prospective study in a large group of patients confirms that MRI yields excellent diagnostic results and markedly decreases the negative appendectomy rate, without an increase in perforation rate.…”

Section: Discussionsupporting

confidence: 80%

“…Technological developments have made ultrafast sequences possible, resulting in shorter examination times and fewer motion artifacts. Detection of appendicitis with MRI has been published in a small group of pregnant and non-pregnant patients [13][14][15][16][17][18][19]. This is, to our knowledge, the first prospective blinded clinical study, in more than 100 patients, to evaluate MRI in patients clinically suspected of having appendicitis.…”

Section: Introductionmentioning

confidence: 98%

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A simple MRI protocol in patients with clinically suspected appendicitis: results in 138 patients and effect on outcome of appendectomy

et al. 2009

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To establish the value of breathhold magnetic resonance imaging (MRI) in the diagnosis of acute appendicitis. Over a 14-month period, 138 patients clinically suspected of having appendicitis were evaluated prospectively with MRI and comprised the study group. Fast turbo spin-echo breathhold T1, T2 and T2 fat suppression sequences were used in coronal and axial planes. The imaging results were recorded separately and subsequently correlated with clinical, radiological and histopathological follow-up. The effect of imaging strategies in patients suspected of appendicitis on hospital resources was calculated. Sixty-two of the 138 patients had a histopathologically proven appendicitis. MRI determined appendicitis in 63 patients, with one examination being false positive. The resulting sensitivity and specificity were 100% and 99%, respectively. MRI showed an alternative diagnosis in 41 of the 75 remaining patients. In 22 of the remaining 34 patients, a normal appendix was depicted with MRI. In two patients, where MRI showed no appendicitis, an alternative diagnosis or normal appendix, an unnecessary appendectomy was performed. The overall effect of using MRI in patients suspected of appendicitis on the use of hospital resources could have been a net saving between 55,746 euros and 72,534 euros. MRI has a high accuracy in detecting and excluding appendicitis, an alternative diagnosis or showing the normal appendix, and can be a valuable and cost-effective tool in the workup of patients clinically suspected of having appendicitis.

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Section: Discussionsupporting

confidence: 80%

Section: Introductionmentioning

confidence: 98%

A simple MRI protocol in patients with clinically suspected appendicitis: results in 138 patients and effect on outcome of appendectomy

et al. 2009

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“…14,15 MRI has been used in combination with ultrasonography for the diagnosis of appendicitis in adults, maintaining a high sensitivity and specificity without effect on negative appendectomy or perforation rate. In children, MRI has been shown to be feasible and effective in diagnosing acute appendicitis, [16][17][18] but reports of clinical outcomes are lacking.…”

Section: Discussionmentioning

confidence: 99%

Ultrasonography/MRI Versus CT for Diagnosing Appendicitis

Aspelund¹,

Fingeret²,

Gross³

et al. 2014

Pediatrics

135

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WHAT'S KNOWN ON THIS SUBJECT: Previous studies have confirmed feasibility of MRI for diagnosis of appendicitis in adults and children. No study has assessed clinical end points when using ultrasound and MRI compared with computed tomography for diagnosis of appendicitis in children.WHAT THIS STUDY ADDS: Radiation-free imaging with ultrasound selectively followed by MRI does not change clinical endpoints compared with CT for diagnosing appendicitis in children, with no difference in time to antibiotic administration, time to appendectomy, negative appendectomy rate, perforation rate, or length of stay. abstract BACKGROUND: Cross-sectional imaging increases accuracy in diagnosing appendicitis. We hypothesized that a radiation-free imaging pathway of ultrasonography selectively followed by MRI would not change clinical end points compared with computed tomography (CT) for diagnosis of acute appendicitis in children. METHODS:We retrospectively reviewed children (,18 years old) who had diagnostic imaging for suspected acute appendicitis between November 2008 and October 2012. Before November 2010 CT was used as the primary imaging modality (group A); subsequently, ultrasonography was the primary imaging modality followed by MRI for equivocal findings (group B). Data collected included time from triage to imaging and treatment and results of imaging and pathology.RESULTS: Six hundred sixty-two patients had imaging for suspected appendicitis (group A = 265; group B = 397, of which 136 [51%] and 161 [41%], respectively, had positive imaging for appendicitis). Negative appendectomy rate was 2.5% for group A and 1.4% for group B. Perforation rate was similar for both groups. Time from triage to antibiotic administration and operation did not differ between groups A and B. There was higher proportion of positive imaging and appendectomies in group A and thus more negative imaging tests in group B (ultrasonography and MRI), but diagnostic accuracy of the 2 imaging pathways was similar. CONCLUSIONS:In children with suspected acute appendicitis, a radiationfree diagnostic imaging of ultrasonography selectively followed by MRI is feasible and comparable to CT, with no difference in time to antibiotic administration, time to appendectomy, negative appendectomy rate, perforation rate, or length of stay.

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“…Other diagnostic tools have been used recently such as MRI scans, radioactive-tagged leukocyte scans, blood cytokine assays and laparoscopy; however, their role in decreasing the frequency of negative explorations in pediatric appendicitis remains to be seen. [19][20][21][22] Delay in reaching the correct diagnosis of appendicitis, as well as its surgical management in the young infants, results in an increased rate of perforation and peritonitis. Perforation rates in infants have been reported between 55% and 94% by several authors.…”

Section: 9-mentioning

confidence: 99%

Acute Appendicitis in Infants: Still a Diagnostic Dilemma

Cherian

Egaily²,

Joseph³

2003

Ann Saudi Med

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Acute appendicitis is the most common pediatric surgical emergency, constituting 10% of all children admitted to the pediatric emergency department.1 However, appendicitis, in infants under 2 years of age is uncommon, constituting only 2% of all cases.2,3 Its incidence is much lower in neonates and young infants. Since the diagnosis is uncommon and hence unsuspected in this younger age group, treatment is often delayed and perforation is almost certain. Although the mortality rate has been significantly reduced by improvements in pre-operative fluid resuscitation, anesthetic and surgical techniques, post-operative care and the use of broad-spectrum antibiotics, late recognition has lead to increased post-operative morbidity and prolonged hospitalization. 4 We report a case of acute appendicitis and perforation in a 78-day old infant, who presented with fever, irritability and abdominal distension. Case ReportA 78-day old male infant presented to the emergency room (ER) with a history of fever, refusal of feeds, constipation, irritability and excessive crying for 24 hours. There was no vomiting. The infant was the product of an uneventful full-term pregnancy and cesarian delivery performed because of fetal distress and shoulder dystocia. The mother had premature rupture of membranes 15 days prior to delivery for which she received intravenous antibiotics. His birth weight was 1850 grams. A septic work up was negative and neonatal screening showed G6PD deficiency. When the patient was seen in the ER, his temperature was 39.2°C, heart rate was 160 per minute and respiratory rate was 34 per minute. He was irritable and crying, and hence examination was difficult.The abdomen was distended, but not rigid. Peristalsis was heard. No mass could be palpated and digital examination of the rectum was unremarkable. Urine examination was normal. His white cell count was 7.7 x 10 3 with 46% neutrophils. Blood chemistry as well CSF analysis was normal. Plain abdominal radiograph showed gasfilled small bowel loops in the central abdomen suggestive of ileus. There was no obvious wall or mucosal thickness nor any intraabdominal calcification. The infant was admitted for further management. Ultrasound examination of the abdomen waslimited due to significant abdominal distension and a large amount of bowel gases; however, no fluid collection or masses were found. Barium enema failed to show any gross abnormality of recto-sigmoid or appendix. There was no evidence of intussusception. A laparotomy was performed seven hours after admission. The appendix was found inflamed showing perforations at the tip as well as the base and the area of right lower quadrant was filled with a fibrinous material. The peritoneal cavity contained free purulent fluid. Appendectomy was performed followed by copious saline washing into all the four quadrants and insertion of Penrose drains. Postoperative CT scan of the abdomen ruled out any intra-peritoneal abscesses. Microscopic examination of the appendix revealed marked luminal dilatation with inspissate...

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MR imaging in children with nonperforated acute appendicitis: value of unenhanced MR imaging in sonographically selected cases.

Cited by 106 publications

References 10 publications

A simple MRI protocol in patients with clinically suspected appendicitis: results in 138 patients and effect on outcome of appendectomy

A simple MRI protocol in patients with clinically suspected appendicitis: results in 138 patients and effect on outcome of appendectomy

Ultrasonography/MRI Versus CT for Diagnosing Appendicitis

Acute Appendicitis in Infants: Still a Diagnostic Dilemma

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