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04-12-2023 | Appendicitis | Review

The Society for Pediatric Radiology Magnetic Resonance Imaging and Emergency and Trauma Imaging Committees’ consensus protocol recommendation for rapid MRI for evaluating suspected appendicitis in children

Authors: Cara E. Morin, Pinar Karakas, Gregory Vorona, Gayathri Sreedher, James M. Brian, Govind B. Chavhan, Taylor Chung, Lindsay M. Griffin, Summer L. Kaplan, Michael Moore, Kathleen Schenker, Subramanian Subramanian, Michael Aquino

Published in: Pediatric Radiology | Issue 1/2024

Abstract

The imaging evaluation of acute abdominal pain in children with suspected appendicitis has evolved to include rapid abdominopelvic MRI (rMRI) over recent years. Through a collaborative effort between the Magnetic Resonance Imaging (MRI) and Emergency and Trauma Imaging Committees of the Society for Pediatric Radiology (SPR), we conducted a survey on the utilization of rMRI to assess practice specifics and protocols. Subsequently, we present a proposed consensus rMRI protocol derived from the survey results, literature review, and discussion and consensus between committee members.

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Cairns C, Kang K (2022) National hospital ambulatory medical care survey: 2020 emergency department summary tables. National Center for Health Statistics (U.S.); [cited 2023 Jan 30]. Available from: https://www.cdc.gov/nchs/ahcd/web_tables.htm

Tseng Y-C, Lee M-S, Chang Y-J, Wu H-P (2008) Acute abdomen in pediatric patients admitted to the pediatric emergency department. Pediatr Neonatol 49:126–134CrossRefPubMed

Expert Panel on Pediatric Imaging, Koberlein GC, Trout AT et al (2019) ACR appropriateness criteria® suspected appendicitis-child. J Am Coll Radiol 16:S252–S263CrossRef

Moore MM, Kulaylat AN, Hollenbeak CS et al (2016) Magnetic resonance imaging in pediatric appendicitis: a systematic review. Pediatr Radiol 46:928–939CrossRefPubMed

D’Souza N, Hicks G, Beable R et al (2021) Magnetic resonance imaging (MRI) for diagnosis of acute appendicitis. Cochrane Database Syst Rev 12:CD012028

Mushtaq R, Desoky SM, Morello F et al (2019) First-line diagnostic evaluation with MRI of children suspected of having acute appendicitis. Radiology 291:170–177CrossRefPubMed

Heye P, Saavedra JSM, Victoria T, Laje P (2020) Accuracy of unenhanced, non-sedated MRI in the diagnosis of acute appendicitis in children. J Pediatr Surg 55:253–256CrossRefPubMed

Martin JF, Mathison DJ, Mullan PC, Otero HJ (2018) Secondary imaging for suspected appendicitis after equivocal ultrasound: time to disposition of MRI compared to CT. Emerg Radiol 25:161–168CrossRefPubMed

Benabbas R, Hanna M, Shah J, Sinert R (2017) Diagnostic accuracy of history, physical examination, laboratory tests, and point-of-care ultrasound for pediatric acute appendicitis in the emergency department: a systematic review and meta-analysis. Acad Emerg Med 24:523–551CrossRefPubMed

10.

Xiao B, Zhang X-M (2010) Magnetic resonance imaging for acute pancreatitis. World J Radiol 2:298–308CrossRefPubMedPubMedCentral

11.

Duigenan S, Oliva E, Lee SI (2012) Ovarian torsion: diagnostic features on CT and MRI with pathologic correlation. AJR Am J Roentgenol 198:W122–W131CrossRefPubMed

12.

Nepal P, Wells M, Ojili V et al (2021) Problem-solving with MRI in acute abdominopelvic conditions, part 1: gastrointestinal, hepatobiliary, and pancreatic diseases. Emerg Radiol 28:1161–1172CrossRefPubMed

13.

Tonolini M, Ravelli A, Villa C, Bianco R (2012) Urgent MRI with MR cholangiopancreatography (MRCP) of acute cholecystitis and related complications: diagnostic role and spectrum of imaging findings. Emerg Radiol 19:341–348CrossRefPubMed

14.

Dillman JR, Trout AT (2019) MRI for first-line evaluation of children suspected of having acute appendicitis. Radiology 291:178–179CrossRefPubMed

15.

Ayyala RS (2023) Practice patterns in use of MRI for appendicitis in the emergency department at Children’s Hospitals: results of a national survey. AJR Am J Roentgenol 1–2

16.

Callahan MJ, Cravero JP (2022) Should I irradiate with computed tomography or sedate for magnetic resonance imaging? Pediatr Radiol 52:340–344CrossRefPubMed

17.

Imler D, Keller C, Sivasankar S et al (2017) Magnetic resonance imaging versus ultrasound as the initial imaging modality for pediatric and young adult patients with suspected appendicitis. Acad Emerg Med 24:569–577CrossRefPubMed

18.

Otero HJ, Smitthimedhin A, Wang CC, Heitzmann MD (2018) Case based simulation in MRI for suspected appendicitis in children. Clin Imaging 48:12–16CrossRefPubMed

19.

Hagedorn KN, Hayatghaibi SE, Levine MH, Orth RC (2019) Cost comparison of ultrasound versus MRI to diagnose adolescent female patients presenting with acute abdominal/pelvic pain using time-driven activity-based costing. Acad Radiol 26:1618–1624CrossRefPubMed

20.

Zens TJ, Rogers AP, Riedesel EL et al (2018) The cost effectiveness and utility of a “quick MRI” for the evaluation of intra-abdominal abscess after acute appendicitis in the pediatric patient population. J Pediatr Surg 53:1168–1174CrossRefPubMed

21.

Didier RA, Hopkins KL, Coakley FV et al (2017) Performance characteristics of magnetic resonance imaging without contrast agents or sedation in pediatric appendicitis. Pediatr Radiol 47:1312–1320CrossRefPubMed

22.

Dibble EH, Swenson DW, Cartagena C et al (2018) Effectiveness of a staged US and unenhanced MR imaging algorithm in the diagnosis of pediatric appendicitis. Radiology 286:1022–1029CrossRefPubMed

23.

James K, Duffy P, Kavanagh RG et al (2020) Fast acquisition abdominal MRI study for the investigation of suspected acute appendicitis in paediatric patients. Insights Imaging 11:78CrossRefPubMedPubMedCentral

24.

Lyons GR, Renjen P, Askin G et al (2017) Diagnostic utility of intravenous contrast for MR imaging in pediatric appendicitis. Pediatr Radiol 47:398–403CrossRefPubMed

25.

Abdeen N, Naz F, Linthorst R et al (2019) Clinical impact and cost-effectiveness of noncontrast MRI in the evaluation of suspected appendiceal abscesses in children. J Magn Reson Imaging 49:e241–e249CrossRefPubMed

26.

James NC, Ahmadian R, Mckee JQ et al (2022) Magnetic resonance imaging availability reduces computed tomography use for pediatric appendicitis diagnosis. Pediatr Emerg Care 38:e219–e224CrossRefPubMed

27.

Covelli JD, Madireddi SP, May LA et al (2019) MRI for pediatric appendicitis in an adult-focused general hospital: a clinical effectiveness study—challenges and lessons learned. Am J Roentgenol 212:180–187CrossRef

28.

Komanchuk J, Martin D-A, Killam R et al (2021) Magnetic resonance imaging provides useful diagnostic information following equivocal ultrasound in children with suspected appendicitis. Can Assoc Radiol J 72:797–805CrossRefPubMed

29.

Lee MH, Eutsler EP, Sheybani EF, Khanna G (2017) Rapid non-contrast magnetic resonance imaging for post appendectomy intra-abdominal abscess in children. Pediatr Radiol 47:935–941CrossRefPubMed

30.

Rosenbaum DG, Askin G, Beneck DM, Kovanlikaya A (2017) Differentiating perforated from non-perforated appendicitis on contrast-enhanced magnetic resonance imaging. Pediatr Radiol 47:1483–1490CrossRefPubMed

31.

Warner J, Desoky S, Tiwari HA et al (2020) Unenhanced MRI of the abdomen and pelvis in the comprehensive evaluation of acute atraumatic abdominal pain in children. AJR Am J Roentgenol 215:1218–1228CrossRefPubMed

32.

Gounder S, Strudwick M (2021) Multimodality imaging review for suspected ovarian torsion cases in children. Radiography 27:236–242CrossRefPubMed

33.

Özdemir O, Metin Y, Metin NO, Küpeli A (2017) Contribution of diffusion-weighted imaging to conventional MRI for detection of haemorrhagic infarction in ovary torsion. BMC Med Imaging 17:56CrossRefPubMedPubMedCentral

34.

Bekci T, Polat AV, Aslan K et al (2016) Diagnostic performance of diffusion-weighted MRI in the diagnosis of ovarian torsion: comparison of torsed and nonaffected ovaries. Clin Imaging 40:1029–1033CrossRefPubMed

35.

Fujii S, Kaneda S, Kakite S et al (2011) Diffusion-weighted imaging findings of adnexal torsion: initial results. Eur J Radiol 77:330–334CrossRefPubMed

36.

Kato H, Kanematsu M, Uchiyama M et al (2014) Diffusion-weighted imaging of ovarian torsion: usefulness of apparent diffusion coefficient (ADC) values for the detection of hemorrhagic infarction. Magn Reson Med Sci 13:39–44CrossRefPubMed

37.

Desoky S, Udayasankar UK (2021) Unenhanced MRI for abdominal pain in the pediatric emergency department: point—safe and comprehensive assessment while reducing delay in care. Am J Roentgenol 216:874–875CrossRef

38.

Brian JM, Moore MM (2021) Unenhanced MRI for abdominal pain in the pediatric emergency department: counterpoint—choice should consider access, patient, and cost. Am J Roentgenol 216:876–877CrossRef

39.

Jennings R, Guo H, Goldin A, Wright DR (2020) Cost-effectiveness of imaging protocols for suspected appendicitis. Pediatrics 145:e20191352. https://doi.org/10.1542/peds.2019-1352

40.

Pooler BD, Hernando D, Reeder SB (2019) Clinical implementation of a focused MRI protocol for hepatic fat and iron quantification. AJR Am J Roentgenol 213:90–95CrossRefPubMed

Title: The Society for Pediatric Radiology Magnetic Resonance Imaging and Emergency and Trauma Imaging Committees’ consensus protocol recommendation for rapid MRI for evaluating suspected appendicitis in children
Authors: Cara E. Morin
Pinar Karakas
Gregory Vorona
Gayathri Sreedher
James M. Brian
Govind B. Chavhan
Taylor Chung
Lindsay M. Griffin
Summer L. Kaplan
Michael Moore
Kathleen Schenker
Subramanian Subramanian
Michael Aquino
Publication date: 04-12-2023
Publisher: Springer Berlin Heidelberg
Keywords: Appendicitis
Pediatric Radiology
Magnetic Resonance Imaging
Magnetic Resonance Imaging
Appendicitis
Pediatric Radiology
Published in: Pediatric Radiology / Issue 1/2024
Print ISSN: 0301-0449
Electronic ISSN: 1432-1998
DOI: https://doi.org/10.1007/s00247-023-05819-y

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The Society for Pediatric Radiology Magnetic Resonance Imaging and Emergency and Trauma Imaging Committees’ consensus protocol recommendation for rapid MRI for evaluating suspected appendicitis in children

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

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