First-Line Diagnostic Evaluation with MRI of Children Suspected of Having Acute Appendicitis

Raza Mushtaq, Sarah M. Desoky, Frank Morello, Dorothy Gilbertson-Dahdal, Geetha Gopalakrishnan, Aaron Leetch, Srinivasan Vedantham, Bobby Kalb, Diego R. Martin, Unni K. Udayasankar

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Abstract

Background Advances in abdominal MRI have enabled rapid, free-breathing imaging without the need for intravenous or oral contrast material. The use of MRI as the primary imaging modality for suspected appendicitis has not been previously studied. Purpose To determine the diagnostic performance of MRI as the initial imaging modality in children suspected of having acute appendicitis. Materials and Methods The study included consecutive patients 18 years of age and younger presenting with acute abdominal pain at a tertiary care institution from January 2013 through June 2016 who subsequently underwent an unenhanced MRI examination as the primary diagnostic imaging modality. Electronic medical records and radiology reports were retrospectively evaluated for the feasibility and diagnostic performance of MRI, with surgical pathology and follow-up electronic records as reference standards. Statistical analyses were performed by using simple binomial proportions to quantify sensitivity, specificity, and accuracy, and exact 95% confidence intervals (CIs) were obtained. Results After exclusions, 402 patients (median age: 13 years; interquartile range [IQR], 9-15 years; 235 female patients; 167 male patients) were included. Sedation for MRI was required in 13 of 402 patients (3.2%; 95% CI: 1.7%, 5.5%). The appendix was visualized in 349 of 402 patients (86.8%; 95% CI: 83.1%, 90%); for the remaining patients, a diagnosis was provided on the basis of secondary signs of appendicitis. The sensitivity, specificity, and accuracy of MRI as the primary diagnostic imaging modality for the evaluation of acute appendicitis were 97.9% (95 of 97; 95% CI: 92.8%, 99.8%), 99% (302 of 305; 95% CI: 97.2%, 99.8%), and 98.8% (397 of 402; 97.1%, 99.6%), respectively. Among patients with negative findings for appendicitis at MRI, an alternate diagnosis was provided in 113 of 304 patients (37.2%; 95% CI: 31.7%, 42.9%). Conclusion When performed as the initial imaging modality in children suspected of having acute appendicitis, MRI examinations had high diagnostic performance for the diagnosis of acute appendicitis and in providing alternative diagnoses.

Original languageEnglish (US)
Pages (from-to)170-177
Number of pages8
JournalRadiology
Volume291
Issue number1
DOIs
StatePublished - Apr 1 2019

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Appendicitis
Confidence Intervals
Diagnostic Imaging
Sensitivity and Specificity
Surgical Pathology
Electronic Health Records
Acute Pain
Tertiary Healthcare
Radiology
Abdominal Pain
Contrast Media
Respiration

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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Mushtaq, R., Desoky, S. M., Morello, F., Gilbertson-Dahdal, D., Gopalakrishnan, G., Leetch, A., ... Udayasankar, U. K. (2019). First-Line Diagnostic Evaluation with MRI of Children Suspected of Having Acute Appendicitis. Radiology, 291(1), 170-177. https://doi.org/10.1148/radiol.2019181959

First-Line Diagnostic Evaluation with MRI of Children Suspected of Having Acute Appendicitis. / Mushtaq, Raza; Desoky, Sarah M.; Morello, Frank; Gilbertson-Dahdal, Dorothy; Gopalakrishnan, Geetha; Leetch, Aaron; Vedantham, Srinivasan; Kalb, Bobby; Martin, Diego R.; Udayasankar, Unni K.

In: Radiology, Vol. 291, No. 1, 01.04.2019, p. 170-177.

Research output: Contribution to journalArticle

Mushtaq, R, Desoky, SM, Morello, F, Gilbertson-Dahdal, D, Gopalakrishnan, G, Leetch, A, Vedantham, S, Kalb, B, Martin, DR & Udayasankar, UK 2019, 'First-Line Diagnostic Evaluation with MRI of Children Suspected of Having Acute Appendicitis', Radiology, vol. 291, no. 1, pp. 170-177. https://doi.org/10.1148/radiol.2019181959
Mushtaq, Raza ; Desoky, Sarah M. ; Morello, Frank ; Gilbertson-Dahdal, Dorothy ; Gopalakrishnan, Geetha ; Leetch, Aaron ; Vedantham, Srinivasan ; Kalb, Bobby ; Martin, Diego R. ; Udayasankar, Unni K. / First-Line Diagnostic Evaluation with MRI of Children Suspected of Having Acute Appendicitis. In: Radiology. 2019 ; Vol. 291, No. 1. pp. 170-177.
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abstract = "Background Advances in abdominal MRI have enabled rapid, free-breathing imaging without the need for intravenous or oral contrast material. The use of MRI as the primary imaging modality for suspected appendicitis has not been previously studied. Purpose To determine the diagnostic performance of MRI as the initial imaging modality in children suspected of having acute appendicitis. Materials and Methods The study included consecutive patients 18 years of age and younger presenting with acute abdominal pain at a tertiary care institution from January 2013 through June 2016 who subsequently underwent an unenhanced MRI examination as the primary diagnostic imaging modality. Electronic medical records and radiology reports were retrospectively evaluated for the feasibility and diagnostic performance of MRI, with surgical pathology and follow-up electronic records as reference standards. Statistical analyses were performed by using simple binomial proportions to quantify sensitivity, specificity, and accuracy, and exact 95{\%} confidence intervals (CIs) were obtained. Results After exclusions, 402 patients (median age: 13 years; interquartile range [IQR], 9-15 years; 235 female patients; 167 male patients) were included. Sedation for MRI was required in 13 of 402 patients (3.2{\%}; 95{\%} CI: 1.7{\%}, 5.5{\%}). The appendix was visualized in 349 of 402 patients (86.8{\%}; 95{\%} CI: 83.1{\%}, 90{\%}); for the remaining patients, a diagnosis was provided on the basis of secondary signs of appendicitis. The sensitivity, specificity, and accuracy of MRI as the primary diagnostic imaging modality for the evaluation of acute appendicitis were 97.9{\%} (95 of 97; 95{\%} CI: 92.8{\%}, 99.8{\%}), 99{\%} (302 of 305; 95{\%} CI: 97.2{\%}, 99.8{\%}), and 98.8{\%} (397 of 402; 97.1{\%}, 99.6{\%}), respectively. Among patients with negative findings for appendicitis at MRI, an alternate diagnosis was provided in 113 of 304 patients (37.2{\%}; 95{\%} CI: 31.7{\%}, 42.9{\%}). Conclusion When performed as the initial imaging modality in children suspected of having acute appendicitis, MRI examinations had high diagnostic performance for the diagnosis of acute appendicitis and in providing alternative diagnoses.",
author = "Raza Mushtaq and Desoky, {Sarah M.} and Frank Morello and Dorothy Gilbertson-Dahdal and Geetha Gopalakrishnan and Aaron Leetch and Srinivasan Vedantham and Bobby Kalb and Martin, {Diego R.} and Udayasankar, {Unni K.}",
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AU - Mushtaq, Raza

AU - Desoky, Sarah M.

AU - Morello, Frank

AU - Gilbertson-Dahdal, Dorothy

AU - Gopalakrishnan, Geetha

AU - Leetch, Aaron

AU - Vedantham, Srinivasan

AU - Kalb, Bobby

AU - Martin, Diego R.

AU - Udayasankar, Unni K.

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N2 - Background Advances in abdominal MRI have enabled rapid, free-breathing imaging without the need for intravenous or oral contrast material. The use of MRI as the primary imaging modality for suspected appendicitis has not been previously studied. Purpose To determine the diagnostic performance of MRI as the initial imaging modality in children suspected of having acute appendicitis. Materials and Methods The study included consecutive patients 18 years of age and younger presenting with acute abdominal pain at a tertiary care institution from January 2013 through June 2016 who subsequently underwent an unenhanced MRI examination as the primary diagnostic imaging modality. Electronic medical records and radiology reports were retrospectively evaluated for the feasibility and diagnostic performance of MRI, with surgical pathology and follow-up electronic records as reference standards. Statistical analyses were performed by using simple binomial proportions to quantify sensitivity, specificity, and accuracy, and exact 95% confidence intervals (CIs) were obtained. Results After exclusions, 402 patients (median age: 13 years; interquartile range [IQR], 9-15 years; 235 female patients; 167 male patients) were included. Sedation for MRI was required in 13 of 402 patients (3.2%; 95% CI: 1.7%, 5.5%). The appendix was visualized in 349 of 402 patients (86.8%; 95% CI: 83.1%, 90%); for the remaining patients, a diagnosis was provided on the basis of secondary signs of appendicitis. The sensitivity, specificity, and accuracy of MRI as the primary diagnostic imaging modality for the evaluation of acute appendicitis were 97.9% (95 of 97; 95% CI: 92.8%, 99.8%), 99% (302 of 305; 95% CI: 97.2%, 99.8%), and 98.8% (397 of 402; 97.1%, 99.6%), respectively. Among patients with negative findings for appendicitis at MRI, an alternate diagnosis was provided in 113 of 304 patients (37.2%; 95% CI: 31.7%, 42.9%). Conclusion When performed as the initial imaging modality in children suspected of having acute appendicitis, MRI examinations had high diagnostic performance for the diagnosis of acute appendicitis and in providing alternative diagnoses.

AB - Background Advances in abdominal MRI have enabled rapid, free-breathing imaging without the need for intravenous or oral contrast material. The use of MRI as the primary imaging modality for suspected appendicitis has not been previously studied. Purpose To determine the diagnostic performance of MRI as the initial imaging modality in children suspected of having acute appendicitis. Materials and Methods The study included consecutive patients 18 years of age and younger presenting with acute abdominal pain at a tertiary care institution from January 2013 through June 2016 who subsequently underwent an unenhanced MRI examination as the primary diagnostic imaging modality. Electronic medical records and radiology reports were retrospectively evaluated for the feasibility and diagnostic performance of MRI, with surgical pathology and follow-up electronic records as reference standards. Statistical analyses were performed by using simple binomial proportions to quantify sensitivity, specificity, and accuracy, and exact 95% confidence intervals (CIs) were obtained. Results After exclusions, 402 patients (median age: 13 years; interquartile range [IQR], 9-15 years; 235 female patients; 167 male patients) were included. Sedation for MRI was required in 13 of 402 patients (3.2%; 95% CI: 1.7%, 5.5%). The appendix was visualized in 349 of 402 patients (86.8%; 95% CI: 83.1%, 90%); for the remaining patients, a diagnosis was provided on the basis of secondary signs of appendicitis. The sensitivity, specificity, and accuracy of MRI as the primary diagnostic imaging modality for the evaluation of acute appendicitis were 97.9% (95 of 97; 95% CI: 92.8%, 99.8%), 99% (302 of 305; 95% CI: 97.2%, 99.8%), and 98.8% (397 of 402; 97.1%, 99.6%), respectively. Among patients with negative findings for appendicitis at MRI, an alternate diagnosis was provided in 113 of 304 patients (37.2%; 95% CI: 31.7%, 42.9%). Conclusion When performed as the initial imaging modality in children suspected of having acute appendicitis, MRI examinations had high diagnostic performance for the diagnosis of acute appendicitis and in providing alternative diagnoses.

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