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Does abdominal pain duration affect the accuracy of first-line MRI for pediatric appendicitis?

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Abstract

Purpose

To compare the accuracy of first-line MRI for pediatric appendicitis between children with different durations of abdominal pain.

Materials and methods

Between November 2012 and September 2013, 364 pediatric patients underwent MRI for clinically suspected appendicitis. Patients were stratified into one group with pain lasting less than or equal to 1 day and pain longer than 1 day.

Results

In patients with early abdominal pain, appendicitis occurred in 83 of 208 patients (39.9%) vs. 49 of 156 patients with pain longer than 1 day (31.4%, p = 0.09). Sensitivity and specificity of MRI in patients with early abdominal pain were 97.6% (95% CI [91.6%–99.3%]) and 94.4% (95% CI [88.9%–97.3%]), respectively, vs. 93.9% (95% CI [83.5%–97.9%]) and 97.2% (95% CI [92.1%–99.4%]), respectively, in patients with pain longer than 1 day in duration (p = 0.36 and p = 0.35 for sensitivity and specificity, respectively).

Conclusions

First-line MRI is accurate for acute appendicitis in children presenting with early abdominal pain, and may be appropriate as the initial examination in children. Further prospective studies are needed to compare MRI vs. ultrasound as the initial examination in children with early abdominal pain to help further delineate a diagnostic imaging algorithm.

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References

  1. Guthery SL, Hutchings C, Dean JM, Hoff C (2004) National estimates of hospital utilization by children with gastrointestinal disorders: analysis of the 1997 kids’ inpatient database. J Pediatr 144(5):589–594

    Article  PubMed  Google Scholar 

  2. Wagner JM, McKinney WP, Carpenter JL (1996) Does this patient have appendicitis? JAMA 276(19):1589–1594

    Article  CAS  PubMed  Google Scholar 

  3. Dixon JM, Elton RA, Rainey JB, Macleod DA (1991) Rectal examination in patients with pain in the right lower quadrant of the abdomen. BMJ 302(6773):386–388

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  4. Maxwell JM, Ragland JJ (1991) Appendicitis. Improvements in diagnosis and treatment. Am Surg 57(5):282–285

    CAS  PubMed  Google Scholar 

  5. Hardin DM Jr (1999) Acute appendicitis: review and update. Am Fam Physician 60(7):2027–2034

    PubMed  Google Scholar 

  6. Brender JD, Marcuse EK, Koepsell TD, Hatch EI (1985) Childhood appendicitis: factors associated with perforation. Pediatrics 76(2):301–306

    CAS  PubMed  Google Scholar 

  7. Stone HH, Sanders SL, Martin JD Jr (1971) Perforated appendicitis in children. Surgery 69(5):673–679

    CAS  PubMed  Google Scholar 

  8. Graham JM, Pokorny WJ, Harberg FJ (1980) Acute appendicitis in preschool age children. Am J Surg 139(2):247–250

    Article  CAS  PubMed  Google Scholar 

  9. Scher KS, Coil JA Jr (1980) Appendicitis: factors that influence the frequency of perforation. South Med J 73(12):1561–1563

    Article  CAS  PubMed  Google Scholar 

  10. Eldar S, Nash E, Sabo E, et al. (1997) Delay of surgery in acute appendicitis. Am J Surg 173(3):194–198

    Article  CAS  PubMed  Google Scholar 

  11. Graff L, Russell J, Seashore J, et al. (2000) False-negative and false-positive errors in abdominal pain evaluation: failure to diagnose acute appendicitis and unnecessary surgery. Acad Emerg Med 7(11):1244–1255

    Article  CAS  PubMed  Google Scholar 

  12. Saito JM, Yan Y, Evashwick TW, Warner BW, Tarr PI (2013) Use and accuracy of diagnostic imaging by hospital type in pediatric appendicitis. Pediatrics 131(1):e37–e44

    Article  PubMed Central  PubMed  Google Scholar 

  13. Raval MV, Deans KJ, Rangel SJ, Kelleher KJ, Moss RL (2012) Factors associated with imaging modality choice in children with appendicitis. J Surg Res 177(1):131–136

    Article  PubMed  Google Scholar 

  14. Aspelund G, Fingeret A, Gross E, et al. (2014) Ultrasonography/MRI versus CT for diagnosing appendicitis. Pediatrics 133(4):586–593

    Article  PubMed  Google Scholar 

  15. Hernanz-Schulman M (2010) CT and US in the diagnosis of appendicitis: an argument for CT. Radiology 255(1):3–7

    Article  PubMed  Google Scholar 

  16. Bachur RG, Dayan PS, Bajaj L, et al. (2012) The effect of abdominal pain duration on the accuracy of diagnostic imaging for pediatric appendicitis. Ann Emerg Med 60(5):582–90.e3.

  17. Herliczek TW, Swenson DW, Mayo-Smith WW (2013) Utility of MRI after inconclusive ultrasound in pediatric patients with suspected appendicitis: retrospective review of 60 consecutive patients. AJR Am J Roentgenol 200(5):969–973

    Article  PubMed  Google Scholar 

  18. Moore MM, Gustas CN, Choudhary AK, et al. (2012) MRI for clinically suspected pediatric appendicitis: an implemented program. Pediatr Radiol 42(9):1056–1063

    Article  PubMed  Google Scholar 

  19. Johnson AK, Filippi CG, Andrews T, et al. (2012) Ultrafast 3-T MRI in the evaluation of children with acute lower abdominal pain for the detection of appendicitis. AJR Am J Roentgenol 198(6):1424–1430

    Article  PubMed  Google Scholar 

  20. Cobben L, Groot I, Kingma L, et al. (2009) A simple MRI protocol in patients with clinically suspected appendicitis: results in 138 patients and effect on outcome of appendectomy. Eur Radiol 19(5):1175–1183

    Article  PubMed  Google Scholar 

  21. Hormann M, Paya K, Eibenberger K, et al. (1998) MR imaging in children with nonperforated acute appendicitis: value of unenhanced MR imaging in sonographically selected cases. AJR Am J Roentgenol 171(2):467–470

    Article  CAS  PubMed  Google Scholar 

  22. Bayraktutan U, Oral A, Kantarci M, et al. (2013) Diagnostic performance of diffusion-weighted MR imaging in detecting acute appendicitis in children: comparison with conventional MRI and surgical findings. J Magn Reson Imaging. 39:1518–1524

  23. Koning JL, Naheedy JH, Kruk PG (2014) Diagnostic performance of contrast-enhanced MR for acute appendicitis and alternative causes of abdominal pain in children. Pediatr Radiol 44(8):948–955

    Article  PubMed  Google Scholar 

  24. Orth RC, Guillerman RP, Zhang W, Masand P, Bisset GS 3rd (2014) Prospective comparison of MR imaging and US for the diagnosis of pediatric appendicitis. Radiology 17:132206

    Google Scholar 

  25. Aspelund G, Fingeret A, Gross E, et al. (2014) Ultrasonography/MRI versus CT for diagnosing appendicitis. Pediatrics 133(4):586–593

    Article  PubMed  Google Scholar 

  26. Incesu L, Coskun A, Selcuk MB, et al. (1997) Acute appendicitis: MR imaging and sonographic correlation. AJR Am J Roentgenol 168(3):669–674

    Article  CAS  PubMed  Google Scholar 

  27. Nikolaidis P, Hwang CM, Miller FH, Papanicolaou N (2004) The nonvisualized appendix: incidence of acute appendicitis when secondary inflammatory changes are absent. AJR Am J Roentgenol 183(4):889–892

    Article  PubMed  Google Scholar 

  28. Trout AT, Towbin AJ, Zhang B (2014) Journal club: the pediatric appendix: defining normal. AJR Am J Roentgenol 202(5):936–945

    Article  PubMed  Google Scholar 

  29. Luckmann R, Davis P (1991) The epidemiology of acute appendicitis in California: racial, gender, and seasonal variation. Epidemiology 2(5):323–330

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

The authors would like to thank Drs. John Hauschildt, Melvin Senac, Christopher Dory, Daryl Evora, Jerry Dwek, Paritosh Khanna, and Daniel Vinocur for interpreting the examinations in this study, as well as Keith Prince and the entire staff from Sharp and Children’s MRI Center.

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Authors and Affiliations

  1. Department of Radiology, University of California San Diego, 200 West Arbor Drive MC 8756, San Diego, CA, 92103-8756, USA

    Jeffrey L. Koning, John H. Naheedy & Peter G. Kruk

  2. Department of Radiology, Rady Children’s Hospital, 8001 Frost Street, San Diego, CA, 92123, USA

    John H. Naheedy & Peter G. Kruk

Authors
  1. Jeffrey L. Koning
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  2. John H. Naheedy
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  3. Peter G. Kruk
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Correspondence to Jeffrey L. Koning.

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Koning, J.L., Naheedy, J.H. & Kruk, P.G. Does abdominal pain duration affect the accuracy of first-line MRI for pediatric appendicitis?. Abdom Imaging 40, 352–359 (2015). https://doi.org/10.1007/s00261-014-0223-9

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  • DOI: https://doi.org/10.1007/s00261-014-0223-9

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