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Chest MRI as an emerging modality in the evaluation of empyema in children with specific indications: Pilot study
Kushaljit S Sodhi1, Anmol Bhatia1, Vaibhav Nichat1
1Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Insights
Chest MRI is a valuable tool for diagnosing pediatric empyema, showing results comparable to CT scans. This imaging technique can help reduce radiation exposure in children with empyema.
Area of Science:
- Pediatric radiology
- Thoracic imaging
- Diagnostic imaging
Background:
- Empyema is a serious condition in children requiring accurate diagnosis.
- Multidetector computed tomography (MDCT) is commonly used but involves radiation exposure.
- Chest magnetic resonance imaging (MRI) offers a radiation-free alternative.
Purpose of the Study:
- To evaluate the diagnostic accuracy of chest MRI in pediatric empyema.
- To compare MRI findings with MDCT in children with empyema.
- To assess the potential of MRI as a radiation-reducing imaging modality.
Main Methods:
- Prospective study of 19 children (5-16 years) with empyema.
- Chest MRI and MDCT performed within 48 hours.
- Independent evaluation of images by two pediatric radiologists using kappa statistics for agreement.
Main Results:
- Near-perfect agreement (kappa=1) between MRI and MDCT for fluid, pleural thickening, enhancement, tube localization, consolidation, and lymphadenopathy.
- MRI detected septations in 84.2% of cases, MDCT in 73.7%.
- High interobserver agreement (kappa=0.81-1.00) for most findings, strong agreement (kappa=0.642) for pleural thickening.
Conclusions:
- Chest MRI is comparable to MDCT for diagnosing pediatric empyema.
- MRI can be used as a problem-solving tool and to reduce radiation exposure.
- Consider MRI in children with empyema, especially when CT is needed for preoperative planning or complication evaluation.
Objectives:
To assess the diagnostic role of chest magnetic resonance imaging (MRI) for evaluating empyema in children with specific indications.
Methods:
Nineteen children (5-16 years) with a diagnosis of empyema were enrolled in this prospective study from January 2018 to February 2020. MRI and multidetector computed tomography (MDCT) of the chest was performed within 48 h of each other. Two pediatric radiologists independently evaluated the MRI and CT images for the presence of fluid and air in the pleural cavity, septations within the fluid, pleural thickening, pleural enhancement, drainage tube tip localization, consolidation, and lymphadenopathy. Kappa test of agreement was used to determine the agreement between the MRI and MDCT findings. Chance-corrected kappa statistics were used for calculating the interobserver variation.
Results:
The kappa test showed almost perfect agreement (κ = 1) between MRI and MDCT for detecting fluid, pleural thickening, pleural enhancement, drainage tube tip localization, consolidation, and lymphadenopathy. Septations within the fluid were detected in 16 (84.2%) patients on MRI, and in 14 (73.7%) patients on MDCT. Almost perfect agreement (κ = 0.81-1.00) was seen for all the findings on CT and MRI between the two radiologists, except for pleural thickening for which a strong agreement (κ = 0.642) was observed.
Conclusion:
MRI is comparable to MDCT for the detection of various findings in children with empyema. MRI may be considered in lieu of CT, as a problem-solving tool and as a radiation-reducing endeavor in children with empyema, specifically, only where CT is required for preoperative planning and evaluation of complications.
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