MRI best modality for diagnosing acute appendicitis in kids, finds study

MRI is the most preferred diagnostic modality for detecting acute appendicitis in kids. It is an efficient initial imaging modality for providing an accurate diagnosis in children suspected of having acute appendicitis: Reports a study published in the journal Radiology, a journal of the Radiological Society of North America.

Appendicitis is a medical emergency characterized by painful swelling and infection of the appendix. The appendix can burst or rupture if not treated. Experts don't know for sure what role the appendix has in the body. Removing it is not harmful as it is considered as a nonvital organ. It is the most common type of emergency surgery for children, but most children recover with no long-term problems.

Non–contrast-Non enhanced MRI can be an effective initial imaging technique in children suspected of having acute appendicitis, with high sensitivity, specificity, and accuracy for detection of acute appendicitis and potential to depict clinically relevant alternative diagnostic findings. Advances in abdominal MRI have enabled rapid, free-breathing imaging without the need for intravenous or oral contrast material. The use of MRI as the primary imaging modality for suspected appendicitis has not been previously studied.

The present study was conducted by Raza Mushtaq et.al from the Departments of Medical Imaging, University of Arizona College of Medicine, which included consecutive patients aged 18 years and younger presenting with acute abdominal pain at a tertiary care institution from January 2013 through June 2016 who subsequently underwent an unenhanced MRI examination as the primary diagnostic imaging modality. Electronic medical records and radiology reports were retrospectively evaluated for the feasibility and diagnostic performance of MRI, with surgical pathology and follow-up electronic records as reference standards. Statistical analyses were performed by using simple binomial proportions to quantify sensitivity, specificity, and accuracy, and exact 95% confidence intervals (CIs) were obtained.

After exclusions, 402 patients, 9–15 years; 235 female patients; 167 male patients were included. Sedation for MRI was required in 13 of 402 patients. The appendix was visualized in 349 of 402 patients; for the remaining patients, a diagnosis was provided on the basis of secondary signs of appendicitis. The sensitivity, specificity, and accuracy of MRI as the primary diagnostic imaging modality for the evaluation of acute appendicitis were 97.9%, 99%, and 98.8%, respectively. Among patients with negative findings for appendicitis at MRI, an alternate diagnosis was provided in 113 of 304 patients.

The researchers concluded that when performed as the initial imaging modality in children suspected of having acute appendicitis, MRI examinations had a high diagnostic performance for the diagnosis of acute appendicitis and in providing alternative diagnoses.

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https://pubs.rsna.org/doi/10.1148/radiol.2019181959