Magnetic resonance imaging in pediatric appendicitis: a systematic review

Michael Moore, Afif N. Kulaylat, Christopher S. Hollenbeak, Brett Engbrecht, Jonathan R. Dillman, Sosamma Methratta

Research output: Contribution to journalReview article

38 Citations (Scopus)

Abstract

Magnetic resonance imaging for the evaluation of appendicitis in children has rapidly increased recently. This change has been primarily driven by the desire to avoid CT radiation dose. This meta-analysis reviews the diagnostic performance of MRI for pediatric appendicitis and discusses current knowledge of cost-effectiveness. We used a conservative Haldane correction statistical method and found pooled diagnostic parameters including a sensitivity of 96.5% (95% confidence interval [CI]: 94.3–97.8%), specificity of 96.1% (95% CI: 93.5–97.7%), positive predictive value of 92.0% (95% CI: 89.3–94.0%) and negative predictive value of 98.3% (95% CI: 97.3–99.0%), based on 11 studies. Assessment of patient outcomes associated with MRI use at two institutions indicates that time to antibiotics was 4.7 h and 8.2 h, time to appendectomy was 9.1 h and 13.9 h, and negative appendectomy rate was 3.1% and 1.4%, respectively. Alternative diagnoses were present in ~20% of cases, most commonly adnexal cysts and enteritis/colitis. Regarding technique, half-acquisition single-shot fast spin-echo (SSFSE) pulse sequences are crucial. While gadolinium-enhanced T1-weighted pulse sequences might be helpful, any benefit beyond non-contrast MRI has not been confirmed. Balanced steady-state free precession (SSFP) sequences are generally noncontributory. Protocols do not need to exceed five sequences; four-sequence protocols are commonly utilized. Sedation generally is not indicated; patients younger than 5 years might be attempted based on the child’s ability to cooperate. A comprehensive pediatric cost-effectiveness analysis that includes both direct and indirect costs is needed.

Original languageEnglish (US)
Pages (from-to)928-939
Number of pages12
JournalPediatric Radiology
Volume46
Issue number6
DOIs
StatePublished - May 1 2016

Fingerprint

Appendicitis
Magnetic Resonance Imaging
Confidence Intervals
Pediatrics
Appendectomy
Cost-Benefit Analysis
Patient Outcome Assessment
Enteritis
Gadolinium
Colitis
Meta-Analysis
Cysts
Radiation
Anti-Bacterial Agents
Costs and Cost Analysis

All Science Journal Classification (ASJC) codes

  • Pediatrics, Perinatology, and Child Health
  • Radiology Nuclear Medicine and imaging

Cite this

Moore, Michael ; Kulaylat, Afif N. ; Hollenbeak, Christopher S. ; Engbrecht, Brett ; Dillman, Jonathan R. ; Methratta, Sosamma. / Magnetic resonance imaging in pediatric appendicitis : a systematic review. In: Pediatric Radiology. 2016 ; Vol. 46, No. 6. pp. 928-939.
@article{f2d1705ba2774d67a388ad27fa607bf4,
title = "Magnetic resonance imaging in pediatric appendicitis: a systematic review",
abstract = "Magnetic resonance imaging for the evaluation of appendicitis in children has rapidly increased recently. This change has been primarily driven by the desire to avoid CT radiation dose. This meta-analysis reviews the diagnostic performance of MRI for pediatric appendicitis and discusses current knowledge of cost-effectiveness. We used a conservative Haldane correction statistical method and found pooled diagnostic parameters including a sensitivity of 96.5{\%} (95{\%} confidence interval [CI]: 94.3–97.8{\%}), specificity of 96.1{\%} (95{\%} CI: 93.5–97.7{\%}), positive predictive value of 92.0{\%} (95{\%} CI: 89.3–94.0{\%}) and negative predictive value of 98.3{\%} (95{\%} CI: 97.3–99.0{\%}), based on 11 studies. Assessment of patient outcomes associated with MRI use at two institutions indicates that time to antibiotics was 4.7 h and 8.2 h, time to appendectomy was 9.1 h and 13.9 h, and negative appendectomy rate was 3.1{\%} and 1.4{\%}, respectively. Alternative diagnoses were present in ~20{\%} of cases, most commonly adnexal cysts and enteritis/colitis. Regarding technique, half-acquisition single-shot fast spin-echo (SSFSE) pulse sequences are crucial. While gadolinium-enhanced T1-weighted pulse sequences might be helpful, any benefit beyond non-contrast MRI has not been confirmed. Balanced steady-state free precession (SSFP) sequences are generally noncontributory. Protocols do not need to exceed five sequences; four-sequence protocols are commonly utilized. Sedation generally is not indicated; patients younger than 5 years might be attempted based on the child’s ability to cooperate. A comprehensive pediatric cost-effectiveness analysis that includes both direct and indirect costs is needed.",
author = "Michael Moore and Kulaylat, {Afif N.} and Hollenbeak, {Christopher S.} and Brett Engbrecht and Dillman, {Jonathan R.} and Sosamma Methratta",
year = "2016",
month = "5",
day = "1",
doi = "10.1007/s00247-016-3557-3",
language = "English (US)",
volume = "46",
pages = "928--939",
journal = "Pediatric Radiology",
issn = "0301-0449",
publisher = "Springer Verlag",
number = "6",

}

Magnetic resonance imaging in pediatric appendicitis : a systematic review. / Moore, Michael; Kulaylat, Afif N.; Hollenbeak, Christopher S.; Engbrecht, Brett; Dillman, Jonathan R.; Methratta, Sosamma.

In: Pediatric Radiology, Vol. 46, No. 6, 01.05.2016, p. 928-939.

Research output: Contribution to journalReview article

TY - JOUR

T1 - Magnetic resonance imaging in pediatric appendicitis

T2 - a systematic review

AU - Moore, Michael

AU - Kulaylat, Afif N.

AU - Hollenbeak, Christopher S.

AU - Engbrecht, Brett

AU - Dillman, Jonathan R.

AU - Methratta, Sosamma

PY - 2016/5/1

Y1 - 2016/5/1

N2 - Magnetic resonance imaging for the evaluation of appendicitis in children has rapidly increased recently. This change has been primarily driven by the desire to avoid CT radiation dose. This meta-analysis reviews the diagnostic performance of MRI for pediatric appendicitis and discusses current knowledge of cost-effectiveness. We used a conservative Haldane correction statistical method and found pooled diagnostic parameters including a sensitivity of 96.5% (95% confidence interval [CI]: 94.3–97.8%), specificity of 96.1% (95% CI: 93.5–97.7%), positive predictive value of 92.0% (95% CI: 89.3–94.0%) and negative predictive value of 98.3% (95% CI: 97.3–99.0%), based on 11 studies. Assessment of patient outcomes associated with MRI use at two institutions indicates that time to antibiotics was 4.7 h and 8.2 h, time to appendectomy was 9.1 h and 13.9 h, and negative appendectomy rate was 3.1% and 1.4%, respectively. Alternative diagnoses were present in ~20% of cases, most commonly adnexal cysts and enteritis/colitis. Regarding technique, half-acquisition single-shot fast spin-echo (SSFSE) pulse sequences are crucial. While gadolinium-enhanced T1-weighted pulse sequences might be helpful, any benefit beyond non-contrast MRI has not been confirmed. Balanced steady-state free precession (SSFP) sequences are generally noncontributory. Protocols do not need to exceed five sequences; four-sequence protocols are commonly utilized. Sedation generally is not indicated; patients younger than 5 years might be attempted based on the child’s ability to cooperate. A comprehensive pediatric cost-effectiveness analysis that includes both direct and indirect costs is needed.

AB - Magnetic resonance imaging for the evaluation of appendicitis in children has rapidly increased recently. This change has been primarily driven by the desire to avoid CT radiation dose. This meta-analysis reviews the diagnostic performance of MRI for pediatric appendicitis and discusses current knowledge of cost-effectiveness. We used a conservative Haldane correction statistical method and found pooled diagnostic parameters including a sensitivity of 96.5% (95% confidence interval [CI]: 94.3–97.8%), specificity of 96.1% (95% CI: 93.5–97.7%), positive predictive value of 92.0% (95% CI: 89.3–94.0%) and negative predictive value of 98.3% (95% CI: 97.3–99.0%), based on 11 studies. Assessment of patient outcomes associated with MRI use at two institutions indicates that time to antibiotics was 4.7 h and 8.2 h, time to appendectomy was 9.1 h and 13.9 h, and negative appendectomy rate was 3.1% and 1.4%, respectively. Alternative diagnoses were present in ~20% of cases, most commonly adnexal cysts and enteritis/colitis. Regarding technique, half-acquisition single-shot fast spin-echo (SSFSE) pulse sequences are crucial. While gadolinium-enhanced T1-weighted pulse sequences might be helpful, any benefit beyond non-contrast MRI has not been confirmed. Balanced steady-state free precession (SSFP) sequences are generally noncontributory. Protocols do not need to exceed five sequences; four-sequence protocols are commonly utilized. Sedation generally is not indicated; patients younger than 5 years might be attempted based on the child’s ability to cooperate. A comprehensive pediatric cost-effectiveness analysis that includes both direct and indirect costs is needed.

UR - http://www.scopus.com/inward/record.url?scp=84971224754&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84971224754&partnerID=8YFLogxK

U2 - 10.1007/s00247-016-3557-3

DO - 10.1007/s00247-016-3557-3

M3 - Review article

C2 - 27229509

AN - SCOPUS:84971224754

VL - 46

SP - 928

EP - 939

JO - Pediatric Radiology

JF - Pediatric Radiology

SN - 0301-0449

IS - 6

ER -