MRI is good first-line option in children with suspected acute appendicitis

MRI is an effective first option when diagnosing young patients with suspected acute appendicitis, reported authors of single-center study published in Radiology.

Ultrasound (US) is commonly used as the first-line option in children with suspected acute appendicitis. When that modality isn’t adequate, clinicians will opt for CT scanning. Both have their drawbacks, however, including the potentially negative effects of radiation inherent with CT and ultrasound’s limited evaluation for alternative diagnoses, wrote Raza Mushtaq, MD, of the University of Arizona College of Medicine, and colleagues.

So where does that leave MRI?

“Advances in MRI have enabled rapid, free-breathing imaging without the need for intravenous or oral contrast material, allowing for a more efficient, comprehensive evaluation of symptom etiology, which may be especially challenging to elicit clinically in a pediatric population,” Mushtaq et al. added. “However, MRI is not routinely used as the primary imaging modality.”

The team analyzed more than 400 patients who were 18 years or younger and presented with acute abdominal pain at a single institution between January 2013 and June 2016. Each patient’s primary diagnostic imaging modality was unenhanced MRI.

Overall, the sensitivity, specificity and accuracy of MRI as the primary imaging modality were 97.9 percent, 99 percent and 98.8 percent, respectively. The appendix was imaged in 86.8 percent of patients, and the remaining cohort was diagnosed based on secondary signs of appendicitis.

“The diagnostic performance and efficiency of current MRI may yield overall value when it is used as a first-line modality in pediatric (emergency department ) ED for acute abdominal pain,” the authors concluded. “Real-world testing of unenhanced MRI at an academic center can yield results that are as good or better than those of US for the diagnosis of acute appendicitis and that are also favorable for identification of the appendix and for the evaluation of other causes of abdominal pain.”

Despite the growing evidence in support of MRI, not all practices may want to implement the modality for pediatric appendicitis, and some practices may decide that cost is too high a barrier, wrote Jonathan R. Dillman, MD, and Andrew T. Trout, MD, both from Cincinnati Children’s Hospital Medical Center, in a related editorial.

“The best diagnostic strategy for children with right lower quadrant abdominal pain who are suspected of having appendicitis will ultimately emphasize the strengths of your department,” the pair wrote. “In our opinion, US, CT, and noncontrast MRI are all appropriate first-line imaging tests for assessing suspected pediatric appendicitis.”