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Diagnostic performance of short noncontrast biparametric 3-T MRI for tonsillar infections: comparison with a full
Jari-Pekka Vierula1, Janne Nurminen2, Ville Jussila2
1Department of Radiology, Turku University Hospital, Turku, Finland. jptvie@gmail.com.
Background:
We investigated whether a short, 5-min magnetic resonance imaging (MRI) protocol consisting of only axial T2-weighted and diffusion-weighted imaging (DWI) sequences can discriminate between tonsillar infections, peritonsillar abscesses and deeply extending abscesses in a retrospective, blinded, multireader setting.
Methods:
We included patients sent by emergency physicians with suspected pharyngotonsillar infections who underwent emergency neck 3-T MRI from April 1 2013 to December 31 2018. Three radiologists (with 10-16 years of experience) reviewed the images for abscesses and their extension into deep neck spaces. Data were reviewed first using only axial T2-weighted Dixon images and DWI (short protocol) and second including other sequences and contrast-enhanced T1-weighted Dixon images (full protocol). Diagnostic accuracy, interobserver agreement, and reader confidence were measured. Surgical findings and clinical course served as standard of reference.
Results:
The final sample consisted of 52 patients: 13 acute tonsillitis with no abscesses, 19 peritonsillar abscesses, and 20 deeply extending abscesses. Using the short protocol, diagnostic accuracy for abscesses across all readers was good-to-excellent: sensitivity 0.93 (95% confidence interval 0.87-0.97), specificity 0.85 (0.70-0.93), accuracy 0.91 (0.85-0.95). Using the full protocol, respective values were 0.98 (0.93-1.00), 0.85 (0.70-0.93), and 0.95 (0.90-0.97), not significantly different compared with the short protocol. Similar trends were seen with detecting deep extension. Interobserver agreement was similar between protocols. However, readers had higher confidence in diagnosing abscesses using the full protocol.
Conclusions:
Short MRI protocol showed good-to-excellent accuracy for tonsillar abscesses. Contrast-enhanced images improved reader confidence but did not affect diagnostic accuracy or interobserver agreement.
Relevance Statement:
Short protocol consisting only of T2-weighted Dixon and DWI sequences can accurately image tonsillar abscesses, which may improve feasibility of emergency neck MRI.
Key Points:
• The short 3-T MRI protocol (T2-weighted images and DWI) was faster (5 min) than the full protocol including T1-weighted contrast-enhanced images (24 min). • The short 3-T MRI protocol showed good diagnostic accuracy for pharyngotonsillar abscesses. • Contrast-enhanced sequences improved reader confidence but did not impact diagnostic accuracy or interobserver agreement.
Insights
A rapid 5-minute magnetic resonance imaging (MRI) protocol accurately detects tonsillar abscesses. This short MRI protocol, using T2-weighted and diffusion-weighted imaging (DWI), offers high diagnostic accuracy for pharyngotonsillar infections.
Area of Science:
- Radiology
- Medical Imaging
- Otolaryngology
Background:
- Pharyngotonsillar infections require accurate and timely diagnosis.
- Distinguishing between tonsillitis, peritonsillar abscess, and deep neck space infections is crucial for appropriate management.
- Magnetic resonance imaging (MRI) is a valuable tool for evaluating these conditions.
Purpose of the Study:
- To evaluate the diagnostic performance of a shortened 5-minute MRI protocol for tonsillar infections.
- To compare the accuracy of a short MRI protocol (T2-weighted and DWI) with a full protocol (including contrast-enhanced T1-weighted images).
- To assess interobserver agreement and reader confidence with both MRI protocols.
Main Methods:
- Retrospective analysis of 52 patients with suspected pharyngotonsillar infections who underwent 3-T neck MRI.
- Images were reviewed by three radiologists using two protocols: a short 5-min protocol (T2-weighted and DWI) and a full protocol (including contrast-enhanced T1-weighted images).
- Diagnostic accuracy, sensitivity, specificity, interobserver agreement, and reader confidence were measured against surgical and clinical outcomes.
Main Results:
- The short MRI protocol demonstrated good-to-excellent diagnostic accuracy (0.91) for tonsillar abscesses, with sensitivity of 0.93 and specificity of 0.85.
- The full protocol showed slightly higher accuracy (0.95) but the difference was not statistically significant.
- Interobserver agreement was similar between protocols, though reader confidence was higher with the full protocol.
Conclusions:
- A concise 5-minute MRI protocol using T2-weighted and DWI sequences is effective for diagnosing tonsillar abscesses.
- While contrast-enhanced images increase reader confidence, they do not significantly improve diagnostic accuracy or interobserver agreement for these infections.
- The short MRI protocol enhances the feasibility of emergency neck imaging for suspected pharyngotonsillar infections.
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