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Visualization of the normal appendix in children: feasibility of a single contrast-enhanced radial gradient recalled
Shailee V Lala1, Naomi Strubel2, Nicole Nocera2
1Department of Radiology, New York University School of Medicine, 660 First Ave., New York, NY, 10016, USA. shailee.lala@nyumc.org.
Background:
Magnetic resonance imaging (MRI) assessment for appendicitis is limited by exam time and patient cooperation. The radially sampled 3-dimensional (3-D) T1-weighted, gradient recalled echo sequence (radial GRE) is a free-breathing, motion robust sequence that may be useful in evaluating appendicitis in children.
Objective:
To compare the rate of detection of the normal appendix with contrast-enhanced radial GRE versus contrast-enhanced 3-D GRE and a multi-sequence study including contrast-enhanced radial GRE.
Materials And Methods:
This was a retrospective study of patients ages 7-18 years undergoing abdominal-pelvic contrast-enhanced MRI between Jan. 1, 2012, and April 1, 2016. Visualization of the appendix was assessed by consensus between two pediatric radiologists. The rate of detection of the appendix for each sequence and combination of sequences was compared using a McNemar test.
Results:
The rate of detection of the normal appendix on contrast-enhanced radial GRE was significantly higher than on contrast-enhanced 3-D GRE (76% vs. 57.3%, P=0.003). The rate of detection of the normal appendix with multi-sequence MRI including contrast-enhanced radial GRE was significantly higher than on contrast-enhanced 3-D GRE (81.3% vs. 57%, P<0.001). There was no significant difference between the rate of detection of the normal appendix on contrast-enhanced radial GRE alone and multi-sequence MRI including contrast-enhanced radial GRE (76% vs. 81.3%, P=0.267).
Conclusion:
Contrast-enhanced radial GRE allows superior detection of the normal appendix compared to contrast-enhanced 3-D GRE. The rate of detection of the normal appendix on contrast-enhanced radial GRE alone is nearly as good as when the contrast-enhanced radial GRE is interpreted with additional sequences.
Insights
A new MRI technique, contrast-enhanced radial GRE, significantly improves normal appendix detection in children compared to standard 3-D GRE. This motion-robust sequence offers comparable results to multi-sequence MRI for appendicitis evaluation.
Area of Science:
- Radiology
- Medical Imaging
- Pediatric Imaging
Background:
- Magnetic resonance imaging (MRI) for appendicitis diagnosis in children is challenged by scan duration and patient cooperation.
- The radially sampled 3-dimensional (3-D) T1-weighted, gradient recalled echo sequence (radial GRE) offers motion robustness and free-breathing capabilities, making it suitable for pediatric appendicitis evaluation.
Purpose of the Study:
- To compare the diagnostic performance of contrast-enhanced radial GRE against contrast-enhanced 3-D GRE for detecting the normal appendix in pediatric patients.
- To evaluate the incremental benefit of adding contrast-enhanced radial GRE to a multi-sequence MRI protocol.
Main Methods:
- Retrospective analysis of abdominal-pelvic contrast-enhanced MRI scans from patients aged 7-18 years (January 2012 - April 2016).
- Appendix visualization was assessed by consensus of two pediatric radiologists.
- McNemar test was used to compare the detection rates between different sequences and combinations.
Main Results:
- Contrast-enhanced radial GRE demonstrated a significantly higher detection rate of the normal appendix compared to contrast-enhanced 3-D GRE (76% vs. 57.3%, P=0.003).
- Multi-sequence MRI including contrast-enhanced radial GRE also showed a significantly higher detection rate than contrast-enhanced 3-D GRE alone (81.3% vs. 57%, P<0.001).
- No significant difference was observed between contrast-enhanced radial GRE alone and the multi-sequence protocol (76% vs. 81.3%, P=0.267).
Conclusions:
- Contrast-enhanced radial GRE provides superior visualization of the normal appendix compared to contrast-enhanced 3-D GRE in pediatric patients.
- Using contrast-enhanced radial GRE alone achieves detection rates comparable to those obtained with multi-sequence MRI protocols.
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