Department of Radiology, Penn State Milton S Hershey Medical Center, Hershey, PA 17033-0850, USA.
Pediatr Radiol. 2012 Sep;42(9):1056-63. doi: 10.1007/s00247-012-2412-4. Epub 2012 Jun 8.
Emergent MRI is now a viable alternative to CT for evaluating appendicitis while avoiding the detrimental effects of ionizing radiation. However, primary employment of MRI in the setting of clinically suspected pediatric appendicitis has remained significantly underutilized.
To describe our institution's development and the results of a fully implemented clinical program using MRI as the primary imaging evaluation for children with suspected appendicitis.
A four-sequence MRI protocol consisting of coronal and axial single-shot turbo spin-echo (SS-TSE) T2, coronal spectral adiabatic inversion recovery (SPAIR), and axial SS-TSE T2 with fat saturation was performed on 208 children, ages 3 to 17 years, with clinically suspected appendicitis. No intravenous or oral contrast material was administered. No sedation was administered. Data collection includes two separate areas: time parameter analysis and MRI diagnostic results.
Diagnostic accuracy of MRI for pediatric appendicitis indicated a sensitivity of 97.6% (CI: 87.1-99.9%), specificity 97.0% (CI: 93.2-99.0%), positive predictive value 88.9% (CI: 76.0-96.3%), and negative predictive value 99.4% (CI: 96.6-99.9%). Time parameter analysis indicated clinical feasibility, with time requested to first sequence obtained mean of 78.7 +/- 52.5 min, median 65 min; first-to-last sequence time stamp mean 14.2 +/- 8.8 min, median 12 min; last sequence to report mean 57.4 +/- 35.2 min, median 46 min. Mean age was 11.2 +/- 3.6 years old. Girls represented 57% of patients.
MRI is an effective and efficient method of imaging children with clinically suspected appendicitis. Using an expedited four-sequence protocol, sensitivity and specificity are comparable to CT while avoiding the detrimental effects of ionizing radiation.
对于评估阑尾炎，急诊 MRI 现在是 CT 的可行替代方法，同时避免电离辐射的有害影响。然而，在临床上疑似患有阑尾炎的儿童中，MRI 的主要应用仍然明显未得到充分利用。
描述我们机构的发展情况，并介绍在临床上疑似患有阑尾炎的儿童中，将 MRI 作为主要影像学评估方法的全面实施临床方案的结果。
对 208 名年龄在 3 至 17 岁的儿童进行了四项序列 MRI 检查，包括冠状位和轴位单次激发涡轮自旋回波（SS-TSE）T2、冠状位谱绝热反转恢复（SPAIR）和轴位 SS-TSE T2 脂肪饱和。这些儿童均因临床疑似阑尾炎而接受检查。未给予静脉或口服造影剂。未给予镇静剂。数据收集包括两个独立的区域：时间参数分析和 MRI 诊断结果。
MRI 对小儿阑尾炎的诊断准确率表明，其敏感度为 97.6%（CI：87.1-99.9%），特异度为 97.0%（CI：93.2-99.0%），阳性预测值为 88.9%（CI：76.0-96.3%），阴性预测值为 99.4%（CI：96.6-99.9%）。时间参数分析表明，该方法具有临床可行性，获取首个序列所需的时间平均值为 78.7 +/- 52.5 分钟，中位数为 65 分钟；从第一个序列到最后一个序列的时间戳平均值为 14.2 +/- 8.8 分钟，中位数为 12 分钟；最后一个序列报告的时间平均值为 57.4 +/- 35.2 分钟，中位数为 46 分钟。平均年龄为 11.2 +/- 3.6 岁。女孩占患者的 57%。
MRI 是一种有效且高效的成像方法，可用于诊断临床上疑似患有阑尾炎的儿童。使用加速的四项序列方案，其敏感度和特异度与 CT 相当，同时避免了电离辐射的有害影响。
