MRI Effective for Pediatric Appendicitis, Even When Read by Nonpediatric Radiologists

Leesburg, VA, November 27, 2018—Unenhanced MRI for suspected appendicitis in pediatric patients is clinically effective when performed in a nonpediatric hospital setting with nonpediatric radiologists, emergency physicians, and surgeons, according to an article in the January 2019 issue of the American Journal of Roentgenology (AJR).

Appendicitis is the most common cause of pediatric emergency surgery with a lifetime prevalence of 7%. Imaging has become standard practice for diagnosing pediatric appendicitis, with ultrasound (US) and CT being the most common modalities used.

Numerous studies performed at children's hospitals by pediatric fellowship–trained radiologists have shown that MRI is a viable alternative to CT for the evaluation of appendicitis. The study sought to determine the feasibility and accuracy of MRI for pediatric appendicitis in an adult-predominant general hospital setting where non–pediatric-trained radiologists routinely interpret the studies.

The study examined cases of 528 pediatric patients who between 2012 ans 2016 underwent MRI after US evaluation yielded equivocal findings. The results showed 10.4% of patients were found to have surgically proven or pathologically proven appendicitis. Sensitivity and specificity of MRI for appendicitis were 96.4% and 98.9%, respectively. Positive and negative predictive values were 91.2% and 99.6%. A normal appendix and abnormalities not involving the appendix were identified on MRI in 21.6% of patients.

Lack of ionizing radiation and no need for IV contrast material or sedation make rapid MRI both attractive and appropriate for imaging clinically suspected appendicitis in children. Pediatric appendix MRI can be interpreted by nonpediatric radiologists with high accuracy, and an imaging algorithm that includes rapid MRI can be both feasible and effective in a nonpediatric subspecialty setting, thus widening the efficacy of pediatric appendix MRI using observers of a less specialized focus.

Founded in 1900, ARRS is the first and oldest radiology society in the United States, and is an international forum for progress in radiology. The Society's mission is to improve health through a community committed to advancing knowledge and skills in radiology. ARRS achieves its mission through an annual scientific and educational meeting, publication of the American Journal of Roentgenology (AJR) and InPractice magazine, topical symposia and webinars, and print and online educational materials. ARRS is located in Leesburg, VA.