Contrast-Enhanced Abdominal MRI for Suspected Appendicitis: How We Do It

Kinner, Sonja; Repplinger, Michael D.; Pickhardt, PJ; Reeder, Scott B.

doi:10.2214/ajr.15.15948

Cited by 16 publications

(6 citation statements)

References 49 publications

(47 reference statements)

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“…MRI was performed on 1.5 T scanners (Signa HDxt CRM or TwinSpeed, Discovery MR450w; GE Medical Systems, Milwaukee, WI) using an 8‐channel body phased array coil and included noncontrast‐enhanced (NCE)‐MRI with diffusion‐weighted imaging (DWI) and contrast‐enhanced (CE)‐MR. Details of the MRI protocol have been previously reported . In brief, it included multiple orthogonal planes of T 2 ‐weighted single‐shot fast spin‐echo, pre‐ and postcontrast T 1 ‐weighted 3D spoiled gradient echo, and DWI.…”

Section: Methodsmentioning

confidence: 99%

“…Details of the MRI protocol have been previously reported. 10 In brief, it included multiple orthogonal planes of T 2weighted single-shot fast spin-echo, pre-and postcontrast T 1 -weighted 3D spoiled gradient echo, and DWI. For contrast-enhanced T 1 -weighted imaging, 0.1 mmol/kg of gadobenate dimeglumine (Multihance, Bracco Diagnostics, Princeton, NJ) was administered intravenously at 2 ml/s, followed by a 20-ml saline flush injected at the same rate.…”

Section: Mri Protocolmentioning

confidence: 99%

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Prospective evaluation of MRI compared with CT for the etiology of abdominal pain in emergency department patients with concern for appendicitis

Harringa

Bracken

Davis

et al. 2019

Magnetic Resonance Imaging

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Background Computed tomography (CT) is commonly used in the Emergency Department (ED) to evaluate patients with abdominal pain, but exposes them to ionizing radiation, a possible carcinogen. MRI does not utilize ionizing radiation and may be an alternative. Purpose To compare the sensitivity of MRI and CT for acute abdominopelvic ED diagnoses. Study Type Prospective, observational cohort. Population ED patients ≥12 years old and undergoing CT for possible appendicitis. Field Strength/Sequence 1.5 T MRI, including T1‐weighted, T2‐weighted, and diffusion‐weighted imaging sequences. Assessment Three radiologists independently interpreted each MRI and CT image set separately and blindly, using a standard case report form. Assessments included likelihood of appendicitis, presence of an alternative diagnosis, and likelihood that the alternative diagnosis was causing the patient's symptoms. An expert panel utilized chart review and follow‐up phone interviews to determine all final diagnoses. Times to complete image acquisition and image interpretation were also calculated. Statistical Tests Sensitivity was calculated for each radiologist and by consensus (≥2 radiologists in agreement) and are reported as point estimates with 95% confidence intervals. Two‐sided hypothesis tests comparing the sensitivities of the three image types were conducted using Pearson's chi‐squared test with the traditional significance level of P = 0.05. Results There were 15 different acute diagnoses identified on the CT/MR images of 113 patients. Using individual radiologist interpretations, the sensitivities of noncontrast‐enhanced MRI (NCE‐MR), contrast‐enhanced MR (CE‐MR), and CT for any acute diagnosis were 77.0% (72.6–81.4%), 84.2% (80.4–88.0%), and 88.7% (85.5–92.1%). Sensitivity of consensus reads was 82.0% (74.9–88.9%), 87.1% (81.0–93.2%), 92.2% (87.3–97.1%), respectively. There was no difference in sensitivities between CE‐MR and CT by individual (P = 0.096) or consensus interpretations (P = 0.281), although NCE‐MR was inferior to CT in both modes of analysis (P < 0.001, P = 0.031, respectively). Data Conclusion The sensitivity of CE‐MR was similar to CT when diagnosing acute, nontraumatic abdominopelvic pathology in our cohort. Level of Evidence: 2 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;50:1651–1658.

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Section: Methodsmentioning

confidence: 99%

Section: Mri Protocolmentioning

confidence: 99%

Prospective evaluation of MRI compared with CT for the etiology of abdominal pain in emergency department patients with concern for appendicitis

Harringa

Bracken

Davis

et al. 2019

Magnetic Resonance Imaging

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“…All subjects underwent contrast-enhanced CT for clinical care, followed immediately by contrast-enhanced MRI, which was performed for research purposes only. The imaging protocol has been reported [17]. Briefly, it includes unenhanced T2-weighted imaging, contrast-enhanced T1-weighted imaging, and DWI.…”

Section: Methodsmentioning

confidence: 99%

Diagnostic Accuracy of MRI Versus CT for the Evaluation of Acute Appendicitis in Children and Young Adults

Kinner

Pickhardt

Riedesel

et al. 2017

American Journal of Roentgenology

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OBJECTIVE Appendicitis is frequently diagnosed in the emergency department, most commonly using CT. The purpose of this study was to compare the diagnostic accuracy of contrast-enhanced MRI with that of contrast-enhanced CT for the diagnosis of appendicitis in adolescents when interpreted by abdominal radiologists and pediatric radiologists. SUBJECTS AND METHODS Our study included a prospectively enrolled cohort of 48 patients (12–20 years old) with nontraumatic abdominal pain who underwent CT and MRI. Fellowship-trained abdominal and pediatric radiologists reviewed all CT and MRI studies in randomized order, blinded to patient outcome. Likelihood for appendicitis was rated on a 5-point scale (1, definitely not appendicitis; 5, definitely appendicitis) for CT, the unenhanced portion of the MRI, and the entire contrast-enhanced MRI study. ROC curves were generated and AUC compared for each scan type for all six readers and then stratified by radiologist type. Image test characteristics, interrater reliability, and reading times were compared. RESULTS Sensitivity and specificity were 85.9% (95% CI, 76.2–92.7%) and 93.8% (95% CI, 89.7–96.7%) for unenhanced MRI, 93.6% (95% CI, 85.6–97.9%) and 94.3% (95% CI, 90.2–97%) for contrast-enhanced MRI, and 93.6% (95% CI, 85.6–97.9%) and 94.3% (95% CI, 90.2–97%) for CT. No difference was found in the diagnostic accuracy or interpretation time when comparing abdominal radiologists to pediatric radiologists (CT, 3.0 min vs 2.8 min; contrast-enhanced MRI, 2.4 min vs 1.8 min; unenhanced MRI, 1.5 min vs 2.3 min). Substantial agreement between abdominal and pediatric radiologists was seen for all methods (κ = 0.72–0.83). CONCLUSION The diagnostic accuracy of MRI to diagnose appendicitis was very similar to CT. No statistically significant difference in accuracy was observed between imaging modality or radiologist subspecialty.

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“…Single‐shot fast spin echo (SSFSE) acquisition is a hallmark of free‐breathing protocols in a setting of acute pain, as it allows for very fast motion‐resistant acquisition of T 2 ‐weighted images . Motion resistance of SSFSE is so substantial that an inability to breath‐hold is not a contraindication for MRI to evaluate patients with acute abdominal pain …”

Section: Mri Protocol In Assessment Of Acute Gynecologic Conditionsmentioning

confidence: 99%

MRI of Acute Gynecologic Conditions

Gunther

Kanmaniraja

Kobi

et al. 2019

Magnetic Resonance Imaging

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Contrast-Enhanced Abdominal MRI for Suspected Appendicitis: How We Do It

Cited by 16 publications

References 49 publications

Prospective evaluation of MRI compared with CT for the etiology of abdominal pain in emergency department patients with concern for appendicitis

Prospective evaluation of MRI compared with CT for the etiology of abdominal pain in emergency department patients with concern for appendicitis

Diagnostic Accuracy of MRI Versus CT for the Evaluation of Acute Appendicitis in Children and Young Adults

MRI of Acute Gynecologic Conditions

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