Value of Gadolinium-Enhanced MRI in Detection of Acute Appendicitis in Children and Adolescents

Rosines, Lucila A; Chow, Daniel; Lampl, Brooke S.; Chen, Susie; Gordon, S.; Mui, Leonora W.; Aspelund, Gudrun; Ruzal-Shapiro, Carrie

doi:10.2214/ajr.13.12093

Cited by 40 publications

(37 citation statements)

References 23 publications

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“…With the diagnostic boundary set at ≥ 7mm, Rosines et al 30 and Herliczek et al 26 reported sensitivities of 94% 30 and 100% 26 and specificities of 100% 30 , 96% 26 respectively. It can be therefore be inferred that the 1mm difference in appendiceal outer diameter measurement made very little difference to reported sensitivity and specificity values and as such, the smaller value (≥ 6mm) is recommended to reduce risk of false negative findings.…”

Section: Discussionmentioning

confidence: 99%

Is magnetic resonance imaging a viable alternative to ultrasound as the primary imaging modality in the diagnosis of paediatric appendicitis? A systematic review

2016

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yesBackground: Appendicitis is the most common cause of acute abdominal pain requiring surgical intervention\ud in paediatric patients. Ultrasound is generally the diagnostic imaging modality of choice, followed\ud by CT, where paediatric appendicitis is suspected. However, high operator dependency and\ud diagnostic restrictions related to anatomical and clinical presentation may limit consistency of application.\ud This paper explores whether MRI is a viable alternative to ultrasound as the primary imaging\ud modality.\ud Method: A systematic review of the literature was undertaken. A search of Medline, Cinahl, PubMed\ud Central and Google Scholar was undertaken supplemented by a review of reference lists, author\ud searching and review of NICE evidence base for existing guidelines. Included studies were assessed for\ud bias using the QUADAS-2 quality assessment tool and data were extracted systematically using a purposefully\ud designed electronic data extraction proforma.\ud Results: Seven studies were included in final review. The age range of participants extended from 0 to 19\ud years. Only one study with a patient age range of 0e14 used sedation. Sensitivity estimates from the\ud included studies ranged from 92% to 100% while specificity ranged from 89% to 100%. A significant\ud variation in the number and type of sequences was noted between the studies.\ud Conclusion: MRI offers high sensitivity and specificity comparable to contrast enhanced CT and greater\ud than ultrasound as reported in the literature. Where accessibility is not a restriction, MRI is a viable\ud alternative to ultrasound in the assessment and diagnosis of paediatric appendicitis. Clinical practice\ud recommendations have been provided to facilitate the translation of evidence into practice.Funding info requested 17/03/201

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Section: Discussionmentioning

confidence: 99%

Is magnetic resonance imaging a viable alternative to ultrasound as the primary imaging modality in the diagnosis of paediatric appendicitis? A systematic review

2016

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“…The number of patients included in these studies ranged from 38–510 and the mean age ranged from 7–14.4 years. In three studies, patients who showed inconclusive results on US examination prior to MRI were included . Patients who underwent MRI were selected and included in this meta‐analysis from studies by Kearl et al (192 out of 583 patients) .…”

Section: Resultsmentioning

confidence: 99%

“…In terms of the reference standard domain, there was generally an unclear risk of bias because the blinding procedure used for the pathologist who determined the final diagnosis was not mentioned in any of the studies. Regarding the flow and timing domain, six studies had an unclear risk of bias because the clinical follow‐up period in cases of negative MRI findings was not mentioned …”

Section: Resultsmentioning

confidence: 99%

Performance of MRI for suspected appendicitis in pediatric patients and negative appendectomy rate: A systematic review and meta‐analysis

Kim

Suh

Yoon

et al. 2017

Magnetic Resonance Imaging

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“…A study conducted by Rosines et al [18] reported that contrast-enhanced images are helpful for the assessment of acute appendicitis in the pediatric population. However, those authors did not include DWI in their MRI protocol, which has proven valuable in other abdominal and bowel diseases [19].…”

Section: Discussionmentioning

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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Value of Gadolinium-Enhanced MRI in Detection of Acute Appendicitis in Children and Adolescents

Abstract: Gadolinium-enhanced images and T2-weighted images are most helpful in the assessment of acute appendicitis in the pediatric population. These findings have led to protocol modifications that have reduced imaging time.

Cited by 40 publications

References 23 publications

Is magnetic resonance imaging a viable alternative to ultrasound as the primary imaging modality in the diagnosis of paediatric appendicitis? A systematic review

Is magnetic resonance imaging a viable alternative to ultrasound as the primary imaging modality in the diagnosis of paediatric appendicitis? A systematic review

Performance of MRI for suspected appendicitis in pediatric patients and negative appendectomy rate: A systematic review and meta‐analysis

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

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