Skip to main content
SpringerLink
Log in

Diagnostic accuracy and patient acceptance of MRI in children with suspected appendicitis

  • Gastrointestinal
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objective

To compare magnetic resonance imaging (MRI) and ultrasound in children with suspected appendicitis.

Methods

In a single-centre diagnostic accuracy study, children with suspected appendicitis were prospectively identified at the emergency department. All underwent abdominal ultrasound and MRI within 2 h, with the reader blinded to other imaging findings. An expert panel established the final diagnosis after 3 months. We evaluated the diagnostic accuracy of three imaging strategies: ultrasound only, conditional MRI after negative or inconclusive ultrasound, and MRI only. Significance between sensitivity and specificity was calculated using McNemar’s test statistic.

Results

Between April and December 2009 we included 104 consecutive children (47 male, mean age 12). According to the expert panel, 58 patients had appendicitis. The sensitivity of MRI only and conditional MRI was 100 % (95 % confidence interval 92–100), that of ultrasound was significantly lower (76 %; 63–85, P < 0.001). Specificity was comparable among the three investigated strategies; ultrasound only 89 % (77–95), conditional MRI 80 % (67–89), MRI only 89 % (77–95) (P values 0.13, 0.13 and 1.00).

Conclusion

In children with suspected appendicitis, strategies with MRI (MRI only, conditional MRI) had a higher sensitivity for appendicitis compared with a strategy with ultrasound only, while specificity was comparable.

Key Points

• In children, MRI has a higher sensitivity for appendicitis than ultrasound.

• Ultrasound followed by MRI in negative or inconclusive findings is accurate.

• The tolerance for ultrasound and MRI in children is comparable.

• MRI can be performed in children in an emergency setting.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Kaiser S, Frenckner B, Jorulf HK (2002) Suspected appendicitis in children: US and CT—a prospective randomized study. Radiology 223:633–638

    Article  PubMed  Google Scholar 

  2. Brenner DJ, Hall EJ (2007) Computed tomography—an increasing source of radiation exposure. New Engl J Med 357:2277–2284

    Article  CAS  PubMed  Google Scholar 

  3. Alibek S, Brand M, Suess C, Wuest W, Uder M, Greess H (2011) Dose reduction in pediatric computed tomography with automated exposure control. Acad Radiol 18:690–693

    Article  PubMed  Google Scholar 

  4. Sauerland S, Jaschinski T, Neugebauer EA (2010) Laparoscopic versus open surgery for suspected appendicitis. Cochrane Database Syst Rev: CD001546

  5. Michael R (2008) Potential of MR-imaging in the paediatric abdomen. Eur J Radiol 68:235–244

    Article  PubMed  Google Scholar 

  6. Israel GM, Malguria N, McCarthy S, Copel J, Weinreb J (2008) MRI vs. ultrasound for suspected appendicitis during pregnancy. J Magn Reson Imaging 28:428–433

    Article  PubMed  Google Scholar 

  7. Oto A, Srinivasan PN, Ernst RD et al (2006) Revisiting MRI for appendix location during pregnancy. AJR Am J Roentgenol 186:883–887

    Article  PubMed  Google Scholar 

  8. Oto A, Ernst RD, Shah R et al (2005) Right-lower-quadrant pain and suspected appendicitis in pregnant women: evaluation with MR imaging—initial experience. Radiology 234:445–451

    Article  PubMed  Google Scholar 

  9. Pedrosa I, Levine D, Eyvazzadeh AD, Siewert B, Ngo L, Rofsky NM (2006) MR imaging evaluation of acute appendicitis in pregnancy. Radiology 238:891–899

    Article  PubMed  Google Scholar 

  10. Cobben LP, Groot I, Haans L, Blickman JG, Puylaert J (2004) MRI for clinically suspected appendicitis during pregnancy. AJR Am J Roentgenol 183:671–675

    Article  PubMed  Google Scholar 

  11. Nitta N, Takahashi M, Furukawa A, Murata K, Mori M, Fukushima M (2005) MR imaging of the normal appendix and acute appendicitis. J Magn Reson Imaging 21:156–165

    Article  PubMed  Google Scholar 

  12. Incesu L, Coskun A, Selcuk MB, Akan H, Sozubir S, Bernay F (1997) Acute appendicitis: MR imaging and sonographic correlation. AJR Am J Roentgenol 168:669–674

    Article  CAS  PubMed  Google Scholar 

  13. Chabanova E, Balslev I, Achiam M et al (2011) Unenhanced MR Imaging in adults with clinically suspected acute appendicitis. Eur J Radiol 79:206–210

    Article  PubMed  Google Scholar 

  14. Leeuwenburgh MMN, Wiarda BM, Wiezer MJ et al (2013) Comparison of imaging strategies with conditional contrast-enhanced CT and unenhanced MR imaging in patients suspected of having appendicitis: A multicenter diagnostic performance study. Radiology 268:135–143

    Article  PubMed  Google Scholar 

  15. Cobben L, Groot I, Kingma L, Coerkamp E, Puylaert J, Blickman J (2009) A simple MRI protocol in patients with clinically suspected appendicitis: results in 138 patients and effect on outcome of appendectomy. Eur Radiol 19:1175–1183

    Article  PubMed  Google Scholar 

  16. Hörmann M, Puig S, Prokesch SR, Partik B, Helbich TH (2002) MR imaging of the normal appendix in children. Eur Radiol 12:2313–2316

    PubMed  Google Scholar 

  17. 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 198:1424–1430

    Article  PubMed  Google Scholar 

  18. Hörmann 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 171:467–470

    Article  PubMed  Google Scholar 

  19. Puylaert JB (1986) Acute appendicitis: US evaluation using graded compression. Radiology 158:355–360

    CAS  PubMed  Google Scholar 

  20. Inci E, Kilickesmez O, Hocaoglu E, Aydin S, Bayramoglu S, Cimilli T (2011) Utility of diffusion-weighted imaging in the diagnosis of acute appendicitis. Eur Radiol 21:768–775

    Article  PubMed  Google Scholar 

  21. McGrath PA (1987) The multidimensional assessment and management of recurrent pain syndromes in children. Behav Res Ther 25:251–262

    Article  CAS  PubMed  Google Scholar 

  22. Oto A, Ernst RD, Ghulmiyyah LM et al (2009) MR imaging in the triage of pregnant patients with acute abdominal and pelvic pain. Abdom Imaging 34:243–250

    Article  PubMed  Google Scholar 

  23. Lessin MS, Chan M, Catallozzi M et al (1999) Selective use of ultrasonography for acute appendicitis in children. Am J Surg 177:193–196

    Article  CAS  PubMed  Google Scholar 

  24. Rice HE, Arbesman M, Martin DJ et al (1999) Does early ultrasonography affect management of pediatric appendicitis? A prospective analysis. J Pediatr Surg 34:754–758

    Article  CAS  PubMed  Google Scholar 

  25. Sivit CJ, Applegate KE, Stallion A et al (2000) Imaging evaluation of suspected appendicitis in a pediatric population: effectiveness of sonography versus CT. AJR Am J Roentgenol 175:977–980

    Article  CAS  PubMed  Google Scholar 

  26. Garcia Peña BM, Mandl KD, Kraus SJ et al (1999) Ultrasonography and limited computed tomography in the diagnosis and management of appendicitis in children. JAMA 282:1041–1046

    Article  PubMed  Google Scholar 

  27. Van Randen A, Laméris W, Van Es HW et al (2011) A comparison of the Accuracy of Ultrasound and Computed Tomography in common diagnoses causing acute abdominal pain. Eur Radiol 21:1535–1545

    Article  PubMed Central  PubMed  Google Scholar 

  28. Worster A, Carpenter C (2008) Incorporation bias in studies of diagnostic tests: how to avoid being biased about bias. CJEM 10:174–175

    PubMed  Google Scholar 

  29. Rankey D, Leach JL, Leach SD (2008) Emergency MRI utilization trends at a tertiary care academic medical center: baseline data. Acad Radiol 15:438–443

    Article  PubMed  Google Scholar 

  30. Leeuwenburgh MMN, Wiarda BM, Bipat S et al (2012) Acute appendicitis on abdominal MR images: training readers to improve diagnostic accuracy. Radiology 264:455–463

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  32. Goldin AB, Khanna P, Thapa M, McBroom JA, Garrison MM, Parisi MT (2011) Revised ultrasound criteria for appendicitis in children improve diagnostic accuracy. Pediatr Radiol 41:993–999

    Article  PubMed  Google Scholar 

  33. Trout AT, Sanchez R, Ladino-Torres MF (2012) Reevaluating the sonographic criteria for acute appendicitis in children: a review of the literature and a retrospective analysis of 246 cases. Acad Radiol 19:1382–1394

    Article  PubMed  Google Scholar 

  34. Taylor GA, Callahan MJ, Rodriguez D, Smink DS (2006) CT for suspected appendicitis in children: an analysis of diagnostic errors. Pediatr Radiol 36:331–337

    Article  PubMed  Google Scholar 

  35. Leeuwenburgh MMN, Jensch S, Gratama JWC et al (2013) MRI features associated with acute appendicitis. Eur Radiol. doi:10.1007/s00330-013-3001-0

    Google Scholar 

  36. Doria AS, Moineddin R, Kellenberger CJ et al (2006) US or CT for diagnosis of appendicitis in children and adults? A meta-analysis. Radiology 241:83–94

    Article  PubMed  Google Scholar 

  37. Krishnamoorthi R, Ramarajan N, Wang NE et al (2011) Effectiveness of a staged US and CT protocol for the diagnosis of pediatric appendicitis: reducing radiation exposure in the age of ALARA. Radiology 259:231–239

    Article  PubMed  Google Scholar 

  38. Brenner D, Elliston C, Hall E, Berdon W (2001) Estimated risks of radiation-induced fatal cancer from pediatric CT. AJR Am J Roentgenol 176:289–296

    Article  CAS  PubMed  Google Scholar 

  39. Westra AE, Zegers MPA, Sukhai RN et al (2011) Discomfort in children undergoing unsedated MRI. Eur J Pediatr 170:771–777

    Article  PubMed Central  PubMed  Google Scholar 

Download references

Acknowledgments

Siemens (Erlangen, Germany), Trial Center Holland Health, Alkmaar, The Netherlands and Forreest Medical School (Trial Center Holland Health, Alkmaar, Netherlands) financially supported this study. These organisations were not involved in designing and conducting this study, did not have access to the data and were not involved in data analysis or preparation of this manuscript.

Bart Wiarda receives financial support for research from Siemens (Erlangen, Germany). None of the other authors have competing interests.

Author information

Authors and Affiliations

  1. Department of Radiology, Medical Centre Alkmaar, Alkmaar, Netherlands

    Mai E. Thieme, Zaldy D. Valdehueza & Bart M. Wiarda

  2. Department of Radiology, Academic Medical Centre Amsterdam, Amsterdam, Netherlands

    Marjolein M. N. Leeuwenburgh & Jaap Stoker

  3. Department of Surgery, Academic Medical Centre Amsterdam, Amsterdam, Netherlands

    Marjolein M. N. Leeuwenburgh

  4. Department of Radiology, Medical Spectrum Twente, Enschede, Netherlands

    Donald E. Bouman

  5. Department of Surgery, Medical Centre Alkmaar, Alkmaar, Netherlands

    Ivar G. J. M. de Bruin, W. Hermien Schreurs & Alexander P. J. Houdijk

Authors
  1. Mai E. Thieme
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marjolein M. N. Leeuwenburgh
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Zaldy D. Valdehueza
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Donald E. Bouman
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ivar G. J. M. de Bruin
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. W. Hermien Schreurs
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Alexander P. J. Houdijk
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Jaap Stoker
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Bart M. Wiarda
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Marjolein M. N. Leeuwenburgh.

Electronic supplementary material

Below is the link to the electronic supplementary material.

ESM 1

(PDF 45 kb)

Rights and permissions

Reprints and permissions

About this article

Cite this article

Thieme, M.E., Leeuwenburgh, M.M.N., Valdehueza, Z.D. et al. Diagnostic accuracy and patient acceptance of MRI in children with suspected appendicitis. Eur Radiol 24, 630–637 (2014). https://doi.org/10.1007/s00330-013-3044-2

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-013-3044-2

Keywords

Search

Navigation