MRI for clinically suspected pediatric appendicitis: an implemented program

Abstract

Background

Emergent MRI is now a viable alternative to CT for evaluating appendicitis while avoiding the detrimental effects of ionizing radiation. However, primary employment of MRI in the setting of clinically suspected pediatric appendicitis has remained significantly underutilized.

Objective

To describe our institution’s development and the results of a fully implemented clinical program using MRI as the primary imaging evaluation for children with suspected appendicitis.

Materials and methods

A four-sequence MRI protocol consisting of coronal and axial single-shot turbo spin-echo (SS-TSE) T2, coronal spectral adiabatic inversion recovery (SPAIR), and axial SS-TSE T2 with fat saturation was performed on 208 children, ages 3 to 17 years, with clinically suspected appendicitis. No intravenous or oral contrast material was administered. No sedation was administered. Data collection includes two separate areas: time parameter analysis and MRI diagnostic results.

Results

Diagnostic accuracy of MRI for pediatric appendicitis indicated a sensitivity of 97.6% (CI: 87.1–99.9%), specificity 97.0% (CI: 93.2–99.0%), positive predictive value 88.9% (CI: 76.0–96.3%), and negative predictive value 99.4% (CI: 96.6–99.9%). Time parameter analysis indicated clinical feasibility, with time requested to first sequence obtained mean of 78.7 +/− 52.5 min, median 65 min; first-to-last sequence time stamp mean 14.2 +/− 8.8 min, median 12 min; last sequence to report mean 57.4 +/− 35.2 min, median 46 min. Mean age was 11.2 +/− 3.6 years old. Girls represented 57% of patients.

Conclusion

MRI is an effective and efficient method of imaging children with clinically suspected appendicitis. Using an expedited four-sequence protocol, sensitivity and specificity are comparable to CT while avoiding the detrimental effects of ionizing radiation.