Diagnostic accuracy and patient acceptance of MRI in children with suspected appendicitis

An implemented MRI program to eliminate radiation from the evaluation of pediatric appendicitis

“…The MRI diagnostic parameters demonstrated in this 30-month study interval are similar to our institution's initial 12-month evaluation, and also to those obtained by several other groups [10,[14][15][16][17][18][19][20][21][22]. The literature has been largely consistent in the following ranges: sensitivity (93%-100%), specificity (89%-100%), PPV (83%-99%), NPV (97%-100%) [10,[14][15][16][17][18][19][20][21][22].…”

“…The use of MRI in this clinical setting provides cross-sectional imaging without exposing the child to the risks of ionizing radiation [6][7][8]. Facilitated by improvements in image quality, increasingly rapid acquisition times, and both accuracy and reliability of radiographic interpretations, the use of MRI in the diagnosis of appendicitis is clinically feasible [10,[14][15][16][17][18][19][20][21][22][23].…”

“…Appendicitis MRI evaluations were performed on patients 5 to 17 years of age, although younger patients (3 or 4 years of age) were also permitted depending on ability to tolerate examination without sedation as determined by the requesting physician. Our sonographers are available on-call 24 hours/day, however, because of the limitations of US, which include lower sensitivity, greater operator-dependence, and potential nonvisualization of the appendix, we have elected to use MRI as the primary imaging modality, similar to our previous use of CT [14,20,24]. If an MRI scanner was not available, CT served as an alternative modality, unless a requesting physician and pediatric radiologist preferred an US.…”

“…While the feasibility and diagnostic accuracy of MRI in this setting have been reported in previous studies, less is known about the associated clinical outcomes, and in some reports sample sizes have been limited [10,[14][15][16][17][18][19][20][21][22]. Our MRI program utilizes a single-stage imaging pathway, without the administration of oral or intravenous contrast, or sedation [14,23].…”

“…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].…”