MR imaging of the normal appendix in children

Hörmann, Marcus; Puig, Stefan; Prokesch, S R; Partik, B.; Helbich, Thomas H.

doi:10.1007/s00330-002-1351-0

Cited by 43 publications

(9 citation statements)

References 24 publications

(48 reference statements)

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“…MRI has been reported to obtain good results for excluding or detecting appendicitis [13][14][15][16][17]19]. Our prospective study in a large group of patients confirms that MRI yields excellent diagnostic results and markedly decreases the negative appendectomy rate, without an increase in perforation rate.…”

Section: Discussionsupporting

confidence: 90%

“…Technological developments have made ultrafast sequences possible, resulting in shorter examination times and fewer motion artifacts. Detection of appendicitis with MRI has been published in a small group of pregnant and non-pregnant patients [13][14][15][16][17][18][19]. This is, to our knowledge, the first prospective blinded clinical study, in more than 100 patients, to evaluate MRI in patients clinically suspected of having appendicitis.…”

Section: Introductionmentioning

confidence: 94%

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A simple MRI protocol in patients with clinically suspected appendicitis: results in 138 patients and effect on outcome of appendectomy

et al. 2009

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To establish the value of breathhold magnetic resonance imaging (MRI) in the diagnosis of acute appendicitis. Over a 14-month period, 138 patients clinically suspected of having appendicitis were evaluated prospectively with MRI and comprised the study group. Fast turbo spin-echo breathhold T1, T2 and T2 fat suppression sequences were used in coronal and axial planes. The imaging results were recorded separately and subsequently correlated with clinical, radiological and histopathological follow-up. The effect of imaging strategies in patients suspected of appendicitis on hospital resources was calculated. Sixty-two of the 138 patients had a histopathologically proven appendicitis. MRI determined appendicitis in 63 patients, with one examination being false positive. The resulting sensitivity and specificity were 100% and 99%, respectively. MRI showed an alternative diagnosis in 41 of the 75 remaining patients. In 22 of the remaining 34 patients, a normal appendix was depicted with MRI. In two patients, where MRI showed no appendicitis, an alternative diagnosis or normal appendix, an unnecessary appendectomy was performed. The overall effect of using MRI in patients suspected of appendicitis on the use of hospital resources could have been a net saving between 55,746 euros and 72,534 euros. MRI has a high accuracy in detecting and excluding appendicitis, an alternative diagnosis or showing the normal appendix, and can be a valuable and cost-effective tool in the workup of patients clinically suspected of having appendicitis.

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 94%

A simple MRI protocol in patients with clinically suspected appendicitis: results in 138 patients and effect on outcome of appendectomy

et al. 2009

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“…Detection of the normal appendix was possible in 18 of 20 patients (90%) and was consistently demonstrated to the coronal section, both on the T1WI and T2WI images. Hormann et al (30) reported that the normal appendix was described by T2WI and T1WI, in 86% and 73% of children, respectively. On T2WI, the normal appendix had a hyperintense center and a hypointense wall, and was mostly hypointense on T1WI.…”

Section: Discussionmentioning

confidence: 99%

MR imaging of the normal appendix and acute appendicitis

Nitta

Takahashi

Furukawa

et al. 2005

Magnetic Resonance Imaging

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Purpose: To describe the MR appearance of the normal appendix and the MR imaging characteristics of acute appendicitis with correlation to pathological severity. Materials and Methods:A total of 20 volunteers participated in this study to demonstrate normal appendices by MR imaging. A total of 37 consecutive patients with clinically diagnosed acute appendicitis were also scanned. T1-weighted (T1WI) spin-echo images, T2-weighted (T2WI) fast spin-echo, and fat-suppressed spectral presaturation inversion recovery T2-weighted (T2SPIR) fast spin-echo images were obtained. The MR criteria for considering acute appendicitis were as follows: 1) thickening of the appendiceal wall with high intensity on T2WI or T2SPIR; 2) dilated lumen filled with high intensity material on T2WI or T2SPIR; and 3) increased intensity of periappendiceal tissue on T2WI or T2SPIR. Results:The visibility of a normal appendix on MR imaging was 90% (18/20). It appeared as a cord-like structure of medium intensity without fluid collection in the lumen. A total of 30 cases with clinically diagnosed acute appendicitis had positive MR findings and all except one were pathologically proven. The one had cecal diverticulitis. These cases demonstrated filled lumen, with a hypointense wall on T1WI and slightly hyperintense on T2WI or T2SPIR. MR findings correlated well with pathological severity, especially a thicker wall, periappendiceal high intensity, and ascites were useful for suspecting severe appendicitis. Conclusion:Correct diagnosis of acute appendicitis was obtained with MRI, and correlated well with its pathological severity. MRI is a powerful alternative for diagnosing acute appendicitis especially for the patients in whom the radiation is major concern. ACUTE APPENDICITIS is one of the most common abdominal diseases and presents as an acute abdomen. The diagnosis is usually based on clinical and laboratory findings, however, approximately one-third of patients with acute appendicitis present with atypical clinical symptoms. This confusion leads to a high prevalence of unnecessary laparotomy, reported at 6% to 16% (1-5). The other cases demonstrate atypical and nonspecific symptoms shared with other abdominal diseases including cholecystitis, gastritis, enterocolitis, diverticulitis, mesenteric adenitis, gynecological disease (e.g., pelvic inflammatory disease [PID], tubo-ovarian abscess, ovarian cyst or torsion, endometriosis, degenerating uterine leiomyoma), and urological disorders (6 -12). In such clinically questionable cases, it is not uncommon that radiological evaluations provide useful information in making a differential diagnosis. An appropriate imaging procedure can prevent surgery delays and minimize the rate of negative laparotomies. Currently, the imaging modalities chosen to demonstrate an inflamed appendix, as well as its complications, are ultrasound (US) and computed tomography (CT). However, MR has not been applied to acute appendicitis.The first objective of this study was to describe the MR appearances of the normal appe...

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“…Although the sensitivity and specificity of CT for appendicitis in children are quite high (greater than 90% for both [5]), CT also has disadvantages, including use of ionizing radiation and associated risks (8,9), need for intravenous contrast material, and relatively limited soft-tissue contrast resolution. Several recent studies in children have shown that magnetic resonance (MR) imaging may be a viable alternative to CT for the evaluation of appendicitis when US is insufficient (10)(11)(12)(13)(14)(15)(16)(17)(18)(19). MR imaging offers very high soft-tissue contrast resolution (which is particularly helpful in young children with a paucity of intra-abdominal fat), is nonionizing, and can be performed without intravenous or oral contrast material.…”

Section: Subject Identificationmentioning

confidence: 99%