Rapid non-contrast magnetic resonance imaging for post appendectomy intra-abdominal abscess in children
Megan H Lee1, Eric P Eutsler2, Elizabeth F Sheybani3
1Mallinckrodt Institute of Radiology, Washington University School of Medicine in St. Louis, 510 S. Kingshighway Blvd., Box 8131, St. Louis, MO, 63110, USA. leemh@wustl.edu.
Background:
Acute appendicitis, especially if perforated at presentation, is often complicated by postoperative abscess formation. The detection of a postoperative abscess relies primarily on imaging. This has traditionally been done with contrast-enhanced computed tomography. Non-contrast magnetic resonance imaging (MRI) has the potential to accurately detect intra-abdominal abscesses, especially with the use of diffusion-weighted imaging (DWI).
Objective:
To evaluate our single-center experience with a rapid non-contrast MRI protocol evaluating post-appendectomy abscesses in children with persistent postsurgical symptoms.
Materials And Methods:
In this retrospective, institutional review board-approved study, all patients underwent a clinically indicated non-contrast 1.5- or 3-Tesla abdomen/pelvis MRI consisting of single-shot fast spin echo, inversion recovery and DWI sequences. All MRI studies were reviewed by two blinded pediatric radiologists to identify the presence of a drainable fluid collection. Each fluid collection was further characterized as accessible or not accessible for percutaneous or transrectal drainage. Imaging findings were compared to clinical outcome.
Results:
Seven of the 15 patients had a clinically significant fluid collection, and 5 of these patients were treated with percutaneous drain placement or exploratory laparotomy. The other patients had a phlegmon or a clinically insignificant fluid collection and were discharged home within 48 h.
Conclusion:
Rapid non-contrast MRI utilizing fluid-sensitive and DWI sequences can be used to identify drainable fluid collections in post-appendectomy patients. This protocol can be used to triage patients between conservative management vs. abscess drainage without oral/intravenous contrast or exposure to ionizing radiation.
Insights
Rapid non-contrast MRI effectively identifies drainable abscesses in children after appendectomy. This imaging technique aids in deciding between conservative management or surgical drainage, avoiding contrast and radiation.
Area of Science:
- Pediatric Radiology
- Abdominal Imaging
- Magnetic Resonance Imaging
Background:
- Post-appendectomy abscesses are common complications, particularly after perforated appendicitis.
- Traditionally, contrast-enhanced CT detects these abscesses, but non-contrast MRI with diffusion-weighted imaging (DWI) shows promise.
- Accurate detection is crucial for timely and appropriate patient management.
Purpose of the Study:
- To assess a rapid, non-contrast MRI protocol for evaluating post-appendectomy abscesses in children.
- To determine the utility of MRI in identifying drainable fluid collections in pediatric patients with persistent postsurgical symptoms.
Main Methods:
- Retrospective study of pediatric patients undergoing non-contrast MRI (1.5- or 3-Tesla) with DWI sequences.
- Two blinded pediatric radiologists reviewed MRI studies to identify and characterize fluid collections.
- Imaging findings were correlated with clinical outcomes and drainage procedures.
Main Results:
- Seven of 15 patients had clinically significant fluid collections requiring intervention.
- Five patients were treated with percutaneous drainage or exploratory laparotomy.
- Other patients with phlegmon or insignificant collections were managed conservatively.
Conclusions:
- Rapid non-contrast MRI with fluid-sensitive and DWI sequences accurately identifies drainable abscesses post-appendectomy.
- This protocol facilitates patient triage for conservative management versus drainage.
- MRI offers a contrast-free, radiation-free alternative for evaluating post-appendectomy complications.
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