Visualization of the normal appendix with MR enterography in children

Area of Science:

• Radiology
• Pediatric Imaging
• Gastrointestinal Imaging

Background:

• Computed tomography (CT) is standard for diagnosing appendicitis in children, but involves radiation exposure.
• Ultrasound (US) is often equivocal for appendicitis diagnosis in pediatric patients.
• Magnetic resonance (MR) imaging offers a radiation-sparing alternative, but its efficacy in detecting the appendix needs further evaluation.

Purpose of the Study:

• To assess the detection rate of the normal appendix in children using oral and intravenous (IV) contrast-enhanced MRI.
• To establish the comparability of MRI appendix detection rates with CT scans.

Main Methods:

• Retrospective review of MR enterography examinations in 58 pediatric patients.
• Recorded appendix detection rates, body mass index (BMI), age, and gender.
• Utilized axial fast imaging employing steady-state acquisition (FIESTA) sequence.

Main Results:

• The normal appendix was detected in 48% of cases (28 out of 58 patients).
• Appendix detection was highest with the axial FIESTA sequence.
• Children with detected appendices had significantly higher BMI compared to those without.
• Age and gender did not significantly impact appendix detection rates.

Conclusions:

• The 48% detection rate of the normal appendix with contrast-enhanced MRI in children is comparable to CT.
• This detection rate is also similar to previously reported rates for non-contrast MRI.
• Findings support the use of MRI as a viable, radiation-sparing option for pediatric appendicitis diagnosis and can inform protocol development.