MRI for Pediatric Appendicitis in an Adult-Focused General Hospital: A Clinical Effectiveness Study-Challenges and...

Area of Science:

• Radiology
• Pediatric Imaging
• Gastrointestinal Imaging

Background:

• Pediatric appendicitis diagnosis can be challenging, especially in non-pediatric specialized centers.
• Ultrasound (US) often yields equivocal findings, necessitating further investigation.
• Accurate and timely diagnosis is crucial for appropriate management and preventing complications.

Purpose of the Study:

• To assess the feasibility and accuracy of magnetic resonance imaging (MRI) for diagnosing appendicitis in pediatric patients.
• To evaluate MRI performance in a general hospital setting with non-pediatric-trained radiologists.
• To determine the clinical effectiveness of unenhanced MRI for pediatric appendicitis.

Main Methods:

• Pediatric patients with equivocal US findings and clinical suspicion for appendicitis underwent MRI.
• A standardized, unenhanced MRI protocol with three sequences (11-minute scan time) was utilized.
• Surgical or pathology reports served as the reference standard for appendicitis diagnosis.

Main Results:

• MRI demonstrated high diagnostic accuracy for pediatric appendicitis, with a sensitivity of 96.4% and specificity of 98.9%.
• Positive and negative predictive values were 91.2% and 99.6%, respectively.
• Unenhanced MRI successfully identified appendicitis in 10.4% of cases and visualized normal appendices or other abnormalities in 21.6%.

Conclusions:

• Unenhanced MRI is clinically effective for diagnosing pediatric appendicitis in general hospitals.
• The technique is reliable even when interpreted by non-pediatric radiologists and managed by non-specialized clinicians.
• MRI offers a valuable, non-contrast imaging option for pediatric appendicitis evaluation.