Fast acquisition abdominal MRI study for the investigation of suspected acute appendicitis in paediatric patients

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Date
2020-06-16
Authors
James, Karl
Duffy, Patrick
Kavanagh, Richard G.
Carey, Brian W.
Power, Stephen
Ryan, David
Joyce, Stella
Feeley, Aoife
Murphy, Peter
Andrews, Emmet
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Springer
Published Version
10.1186/s13244-020-00882-7
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Abstract
Objectives: To assess the diagnostic accuracy of fast acquisition MRI in suspected cases of paediatric appendicitis presenting to a tertiary referral hospital. Materials and methods: A prospective study was undertaken between May and October 2017 of 52 children who presented with suspected appendicitis and were referred for an abdominal ultrasound. All patients included in this study received both an abdominal ultrasound and five-sequence MRI consisting of axial and coronal gradient echo T2 scans, fat-saturated SSFSE and a diffusion-weighted scan. Participants were randomised into groups of MRI with breath-holds or MRI with free breathing. A patient satisfaction survey was also carried out. Histopathology findings, where available, were used as a gold standard for the purposes of data analysis. Statistical analysis was performed, and p values < 0.05 were considered statistically significant. Results: Ultrasound had a sensitivity and specificity of 25% and 92.9%, respectively. MRI with breath-hold had a sensitivity and specificity of 81.8% and 66.7%, respectively, whilst MRI with free breathing was superior with sensitivity and specificity of 92.3% and 84.2%, respectively. MRI with free breathing was also more time efficient (p < 0.0001). Group statistics were comparable (p < 0.05). Conclusions: The use of fast acquisition MRI protocols, particularly free breathing sequences, for patients admitted with suspected appendicitis can result in faster diagnosis, treatment and discharge. It also has a statistically significant diagnostic advantage over ultrasound. Additionally, the higher specificity of MR can reduce the number of negative appendectomies performed in tertiary centres.
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Keywords
Acute appendicitis , Magnetic resonance imaging , Paediatric , Ultrasound
Citation
James, K., Duffy, P., Kavanagh, R. G., Carey, B. W., Power, S., Ryan, D., Joyce, S., Feeley, A., Murphy, P., Andrews, E., McEntee, M. F., Moore, M., Bogue, C., Maher, M. M. and O’ Connor, O. J. (2020) 'Fast acquisition abdominal MRI study for the investigation of suspected acute appendicitis in paediatric patients', Insights into Imaging, 11(1), 78 (11 pp). doi: 10.1186/s13244-020-00882-7
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https://insightsimaging.springeropen.com/articles/10.1186/s13244-020-00882-7
URI
https://hdl.handle.net/10468/10760
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Medicine - Journal Articles
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© The Author(s). 2020. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.