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Is Oral Contrast Beneficial for Visualization of the Appendix in Low-Weight Children?
Gali Shapira-Zaltsberg1,2, Maria Dien Esquivel1,2, Nicholas Mitsakakis3
1Department of Medical Imaging, 27338CHEO, ON, Canada.
Insights
Oral contrast does not improve appendix visualization on CT scans for low-weight pediatric patients. However, using oral contrast did enhance radiologist agreement when assessing appendix visibility in these children.
Area of Science:
- Radiology
- Pediatric Imaging
Background:
- Oral contrast has not been proven to improve Computed Tomography (CT) diagnostic accuracy for appendicitis in children.
- Previous studies lacked stratification by weight or body mass index, leaving a gap in understanding its utility in specific pediatric subgroups.
Purpose of the Study:
- To evaluate the effectiveness of oral contrast in visualizing the appendix in younger, lower-weight pediatric patients undergoing CT scans.
- To determine if oral contrast aids appendix identification in a specifically defined pediatric cohort.
Main Methods:
- Retrospective analysis of 100 pediatric patients (2-10 years) in the lower weight quartile who underwent contrast-enhanced CT.
- Comparison of appendix visualization rates between patients who received oral contrast (n=37) and those who did not (n=63).
- Independent assessment by two pediatric radiologists, with a third acting as a tie-breaker; statistical analysis using Chi-squared test and Cohen's Kappa coefficient.
Main Results:
- No statistically significant difference was found in appendix visualization between the oral contrast and no oral contrast groups (P=1).
- Inter-rater reliability for appendix visualization was significantly higher in the group that received oral contrast (Cohen's Kappa = 0.91) compared to the group without (Cohen's Kappa = 0.33), P=0.007.
Conclusions:
- Oral contrast administration does not significantly improve the visualization of the appendix in low-weight pediatric patients on CT.
- While not improving visualization, oral contrast did enhance inter-rater reliability among radiologists assessing appendix visibility in this cohort.
- Further research is recommended to clarify the specific role of oral contrast for isolated appendicitis indication in pediatric CT.
Abstract:
Purpose: It has been shown that oral contrast does not improve the diagnostic accuracy of Computed Tomography (CT) for appendicitis in pediatric patients; however, the cohorts in these studies were not stratified by weight or body mass index. The purpose of this study is to assess the benefit of oral contrast administration for identifying the appendix in younger children in the lower weight quartile. Materials and Methods: This retrospective study comprised 100 patients (2-10 years) in lower weight quartile who had intravenous contrast-enhanced CT of the abdomen and pelvis, 37 of which with oral contrast, and 63 without. A pediatric radiologist and a pediatric radiology fellow independently assessed whether the appendix was visualized or not. In case of discrepancy, an additional pediatric radiologist was the "tie-breaker." Chi-squared test was used to compare the proportion of visualized appendix between the groups (with and without oral contrast). Inter-rater reliability was determined using Cohen's Kappa coefficient. Results: There was no significant difference in the visualization of the appendix between the group with oral contrast and without (P = 1). The Cohen Kappa coefficients were .33 (.05, .62) and .91 (.73, 1.00) for the "no oral" and "oral" groups, respectively, yielding evidence of a difference (P = .007). Conclusions: There was no significant difference in the visualization of the appendix using CT with or without oral contrast in low-weight pediatric patients. The inter-rater reliability, however, was significantly higher in the group given oral contrast. Additional studies assessing the value of oral contrast for the sole indication of appendicitis may provide clearer results.
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