Practical Imaging Strategies for Acute Appendicitis in Children

Abstract

When each modality is optimally used, a stepwise imaging approach that begins with graded compression US and proceeds to CT or MRI in select cases is currently best practice.

Reliability of Standardized Reporting System of acute appendicitis in adults at low-dose 320-rows CT

“…Previous study reported that the appendix was visualized on CT in 89 patients, of whom 71 (80%) had pathologically proven appendicitis (25). Another studied added that increased appendiceal caliber alone is not a reliable indicator of appendicitis and must be considered alongside the patient's clinical history and other imaging ndings to avoid misdiagnosis (4)(5)(6)(7)(8). Imaging ndings associated with appendicitis included appendiceal diameter (odds ratio = 14; p = 0.002), and appendiceal mucosal hyper enhancement (odds ratio = 8.7; p < 0.001) (25).…”

“…The extra-luminal gas was de ned as focal areas of free gas outside of the bowel lumen (4-7). The Key CT ndings involving the cecum involve the cecal apex and include cecal apical thickening, the arrowhead sign, and the cecal bar sign (5)(6)(7)(8).…”

MRI of acute appendicitis

“…These tailored protocols result in rapid examinations, on the order of 15 minutes . Given the urgent nature of these examinations and the epidemiology of appendicitis (ie, the vast majority of patients are old enough to remain still for the length of the examination), it is important to note that sedation is generally not offered …”

“…14 Given the urgent nature of these examinations and the epidemiology of appendicitis (ie, the vast majority of patients are old enough to remain still for the length of the examination), it is important to note that sedation is generally not offered. 15 Widespread adoption of MRI in suspected pediatric appendicitis has been hindered by access. While large academic institutions as well as dedicated pediatric hospitals generally enjoy 24/7 MRI availability, this is not necessarily the case in all locales.…”

Is it possible to diagnose perforative appendicitis in children with ultrasound?

“…Ультрасонографія (УСГ) у дітей, за рекомендаціями Американської педіатричної академії та Американської асоціації дитячих хірургів, вважається початковим методом інструментальної діагностики для підтвердження діагнозу гострого апендициту [10]. Для УСГ-діагностики гострого апендициту запропоновано багато критеріїв, які широко використовуються у клінічній практиці [6,14,17], проте мож-ливості УСГ для розмежування неускладненого та ускладненого гострого апендициту, зокрема перфоративного, вивчені недостатньо.…”