Adult-focused radiologists can diagnose pediatric appendicitis with MRI

MRI can effectively diagnose appendicitis in pediatric patients even when performed in a non-pediatric setting by radiologists not trained in the specialty, reported authors of a new American Journal of Roentgenology study.

Both ultrasound and CT have demonstrated good sensitivity and specificity for assessing appendicitis in children, however each has its own challenges, wrote lead author James D. Covelli, with San Antonio Military Medical Center in Fort Sam Houston, Texas, and colleagues. Therefore, they set out to determine if MRI could become a viable alternative.

A total of 528 pediatric patients, with an average age of 9.9 years old, underwent MRI between 2012 and 2016. All received MRI scans without IV contrast nor a sedative after ultrasound could not determine a definite diagnosis. Researchers used a three sequence MRI protocol which took 11 minutes.

More than 10 percent of patients had surgically- or pathologically-proven appendicitis. MRI achieved a sensitivity of 96.4 percent and a specificity of 98.9 percent. Results demonstrated more than 21 percent of patients had a normal appendix or issues unrelated to the appendix.

“Our results show sensitivity and specificity values comparable to those reported in the recent literature and show that MRI can be accurate in non-pediatric hospital settings with non-pediatric radiologists interpreting examinations,” Covelli and colleagues wrote.

The authors did find non-pediatric radiologists were less familiar and less comfortable with reading body MRI scans of children. Many radiologists have little exposure to this area of interpretation, according to Covelli et al. At the authors’ institution, this is magnified by the fact that all non-pregnant adult patients with suspected appendicitis undergo CT, not MRI.

To overcome these challenges, Covelli and colleagues created and implemented an “image-rich, evidence-based” campaign in the pediatric radiology department to educate all providers. Educational materials, grand rounds, conferences and how-to lectures also helped to slowly increase confidence and trust in MRI interpretation.

“Pediatric appendix MRI can be interpreted by non-pediatric radiologists with high accuracy, and an imaging algorithm that includes rapid MRI can be both feasible and effective in a non-pediatric subspecialty setting, thus widening the efficacy of pediatric appendix MRI using observers of a less specialized focus,” the authors concluded.