MRI for Pediatric Appendicitis in an Adult-Focused General Hospital: A Clinical Effectiveness Study—Challenges and Lessons Learned

Covelli, James; Madireddi, Sunthosh P; May, Lauren A.; Costello, Justin E.; Lisanti, Christopher J.; Carlson, Christian L.

doi:10.2214/ajr.18.19825

Cited by 16 publications

(10 citation statements)

References 22 publications

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“…Other considerations for children include an incomplete MRI due to fear from claustrophobia, staying still, and noise emitted from MRI. These concerns can be addressed with child and parental counseling or sedation[ 54 ].…”

Section: Imaging Studiesmentioning

confidence: 99%

Acute appendicitis–advances and controversies

Teng¹,

Thong²,

Lau³

et al. 2021

WJGS

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Being one of the most common causes of the acute abdomen, acute appendicitis (AA) forms the bread and butter of any general surgeon’s practice. With the recent advancements in AA’s management, much controversy in diagnostic algorithms, possible differential diagnoses, and weighing the management options has been generated, with no absolute consensus in the literature. Since Alvarado described his eponymous clinical scoring system in 1986 to stratify AA risk, there has been a burgeoning of additional scores for guiding downstream management and mortality assessment. Furthermore, advancing literature on the role of antibiotics, variations in appendicectomy, and its adjuncts have expanded the surgeon’s repertoire of management options. Owing to the varied presentation, diagnostic tools, and management of AA have also been proposed in special groups such as pregnant patients, the elderly, and the immunocompromised. This article seeks to raise the critical debates about what is currently known about the above aspects of AA and explore the latest controversies in the field. Considering the ever-evolving coronavirus disease 2019 situation worldwide, we also discuss the pandemic’s repercussions on patients and how surgeons’ practices have evolved in the context of AA.

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Section: Imaging Studiesmentioning

confidence: 99%

Acute appendicitis–advances and controversies

Teng¹,

Thong²,

Lau³

et al. 2021

WJGS

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“…Recent studies have raised the concern for gadolinium deposition in tissues; however, the clinical significance of this finding is uncertain [34]. It is feasible that certain pediatric MRI protocols can be obtained without the use of gadolinium, such as MR enterography, musculoskeletal infection or acute appendicitis protocols [35][36][37][38][39].…”

Section: Limited Use Of Gadoliniummentioning

confidence: 99%

Strategies to perform magnetic resonance imaging in infants and young children without sedation

et al. 2021

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Given the increasing use of MRI in the pediatric population, the need for sedation in MRI performed in young children is a topic of growing importance. Although sedation is generally tolerated well by children, the financial and operational impacts of anesthesia on MRI workflow, as well as potential adverse effects of anesthetic medications, highlight the need to perform MRI in children without sedation whenever possible. This review focuses on current techniques to facilitate non-sedation MRI in children, including exam preparation with MRI simulation; asleep but not sedated techniques; awake and relaxed techniques using certified child life specialists, animal-assisted therapy, a child-friendly environment and in-scan entertainment; and non-sedated MRI protocol modifications such as shorter scan time, prioritizing sequences, reducing motion artifact, noise reduction, limiting use of gadolinium, employing an open MRI and modifying protocols.

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“…A recent study by Covelli et al demonstrated the feasibility of implementing a pediatric appendicitis MR protocol in a general adult hospital with non-pediatric radiologists, emergency physicians, and surgeons. 39 While this is a single study, it lays the foundation for pediatric appendicitis MR to move from academic centers into community hospitals. Another study published earlier this year explored the utility of using MR as a first line imaging modality in children with suspected appendicitis.…”

Section: Overview Of Imaging Techniquesmentioning

confidence: 99%

Falling through the worm hole: an exploration of the imaging workup of the vermiform appendix in the pediatric population

2019

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Despite the thousands of articles discussing appendicitis in the literature, the dilemma of how to best diagnosis and manage pediatric appendicitis remains unsettled. Over the past decade, evidence has been mounting about the use of antibiotics as the sole therapy in uncomplicated appendicitis in the adult population. This debate has even recently bled over into the lay press. While this change in practice pattern is still in its infancy for the pediatric population, radiologists should be aware of this change in therapy and how it can impact the imaging work-up and relevant findings. This article concisely summarizes the imaging findings and various imaging pathways to arrive at the diagnose of appendicitis with an emphasis of how to best be of use to our surgical colleagues in this evolving paradigm. It also highlights venues for further research, namely increasing accuracy of differentiating complicated from uncomplicated appendicitis.

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MRI for Pediatric Appendicitis in an Adult-Focused General Hospital: A Clinical Effectiveness Study—Challenges and Lessons Learned

Cited by 16 publications

References 22 publications

Acute appendicitis–advances and controversies

Acute appendicitis–advances and controversies

Strategies to perform magnetic resonance imaging in infants and young children without sedation

Falling through the worm hole: an exploration of the imaging workup of the vermiform appendix in the pediatric population

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