Diagnostic performance of contrast-enhanced MR for acute appendicitis and alternative causes of abdominal pain in children

Abstract

Contrast-enhanced MRI is capable of accurately diagnosing acute appendicitis while detecting many alternative entities of abdominal pain, and it allows good visualization of the appendix. Further evaluation is needed to determine whether contrast-enhanced MRI provides an advantage over non-enhanced MRI for imaging evaluation of acute abdominal pain in the pediatric population.

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 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]. Though most studies have achieved comparable diagnostic accuracy, institutions have varied in their application of MRI.…”

“…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].…”

“…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].…”