MRI for clinically suspected pediatric appendicitis: an implemented program

Moore, Michael J.; Gustas, Cristy; Choudhary, Arabinda K.; Methratta, Sosamma; Hulse, Michael A.; Geeting, Glenn K.; Eggli, Kathleen D.; Boal, Danielle K.

doi:10.1007/s00247-012-2412-4

Cited by 97 publications

(60 citation statements)

References 13 publications

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“…First, although we reported on performance of each imaging pathway in diagnosing appendicitis, our main study question was not of diagnostic accuracy. This has been reported previously in the 95% to 100% range, 15,17,18 but our results indicated similarly high sensitivity, specificity, and negative and positive predictive value of ultrasonography-MRI as for CT. Our MRIs were usually performed after an equivocal ultrasonography, and patients with positive ultrasonography for acute appendicitis usually did not undergo additional imaging. Therefore, the true sensitivity and specificity of MRI could not be determined.…”

Section: Figuresupporting

confidence: 91%

“…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%

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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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Section: Figuresupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Ultrasonography/MRI Versus CT for Diagnosing Appendicitis

Aspelund¹,

Fingeret²,

Gross³

et al. 2014

Pediatrics

135

View full text Add to dashboard Cite

show abstract

“…In a retrospective case series, Herliczek et al 16 found that sensitivity and specificity of MRI for acute appendicitis in children with inconclusive US findings were 100 and 96%, respectively. Although MRI currently lacks the near-universal availability of US and CT, early studies 16,17 demonstrate excellent diagnostic accuracy and present a potential imaging option to avoid the risks of ionizing radiation associated with CT.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Children With Suspected Appendicitis and Incompletely Visualized Appendix on Ultrasound

et al. 2014

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Objectives: The objective was to review the clinical outcomes of children with suspected appendicitis after an ultrasound (US) examination fails to fully visualize the appendix, the diagnostic characteristics of US in children with suspected appendicitis, and the predictive value of secondary signs of appendicitis when the appendix is not fully visualized.Methods: This was a retrospective health record review of children aged 3 to 17 years presenting to a tertiary pediatric emergency department (ED) with suspected appendicitis. Descriptive statistics and diagnostic test characteristics are reported.Results: Overall, 968 children had US. The appendix was fully visualized in 442 cases (45.7%), and 526 (54.3%) children had incompletely visualized appendices. The disposition of those with incompletely visualized appendices were as follows: 59.1% were discharged home, 10.5% went directly to the operating room, and 30.4% were admitted to the hospital for further observation. Of those discharged home based on clinical findings after incompletely visualized appendices, fewer than 0.3% ended up having appendicitis. Ultimately 15.6% of children with incompletely visualized appendices had pathologyconfirmed appendicitis. The sensitivity and specificity of US for children with fully visualized appendices were 99.5% (95% confidence interval [CI] = 96.7% to 100%) and 81.3% (95% CI = 75.2% to 86.2%), respectively. The sensitivity and specificity for the presence of any secondary sign in diagnosing appendicitis were 40.2% (95% CI = 29.6% to 51.7%) and 90.6% (95% CI = 87.5% to 93.2%), respectively. Conclusions:Children with incompletely visualized appendices on US can be safely discharged home based on clinical findings with an acceptable rate of missed appendicitis. Children with nonreassuring clinical examinations following incompletely visualized appendices on US may benefit from further imaging studies prior to appendectomy, to reduce the rate of negative appendectomy. While the presence of secondary signs of inflammation can be used to rule in appendicitis, statistical strength to rule out appendicitis in the absence of secondary signs is insufficient.ACADEMIC EMERGENCY MEDICINE 2014;21:538-542

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“…Previous efforts to reduce radiation exposure have focused on reducing the number of CT scans performed through the prerequisite use of algorithms with various combinations of clinical criteria and ultrasound (US) [9][10][11][12][13]. Recently, magnetic resonance imaging (MRI) has been introduced as an alternative imaging modality for suspected appendicitis [10,[14][15][16][17][18][19][20][21][22].…”

mentioning

confidence: 99%