Lyons Gray R, Renjen Pooja, Askin Gulce, Giambrone Ashley E, Beneck Debra, Kovanlikaya Arzu
Department of Radiology, New York-Presbyterian Hospital/Weill Cornell Medicine, 525 E. 68th St., F631E, New York, NY, 10065, USA.
Department of Biostatistics and Epidemiology, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, NY, USA.
Pediatr Radiol. 2017 Apr;47(4):398-403. doi: 10.1007/s00247-016-3775-8. Epub 2017 Jan 21.
Magnetic resonance imaging (MRI) is increasingly employed as a diagnostic modality for suspected appendicitis in children. However, there is uncertainty as to which MRI sequences are sufficient for safe, timely and accurate diagnosis. Several recent studies have described different MRI protocols, including exams both with and without the use of intravenous contrast.
We hypothesized that intravenous contrast may be useful in some patients but could be safely omitted in others.
All MRI examinations (n=112) performed at our institution for evaluating appendicitis in children were retrospectively reevaluated. Exams were reread by pediatric radiologists under three conditions: With postcontrast images, Without postcontrast images, and Without/With - selective use of postcontrast sequences only when needed for diagnostic certainty. Samples were scored as positive, negative or equivocal for appendicitis. Findings were compared to pathological or clinical follow-up in the medical record.
Without the use of intravenous contrast yielded more equivocal results (12.4%) compared to With contrast (3.4%). By selectively using postcontrast sequences, the Without/With group yielded fewer equivocal results (1.1%) compared to Without while also reducing contrast use 79.8% compared to the With contrast group. No significant differences in conditional sensitivity or conditional specificity were detected among the three groups.
MRI diagnosis of acute appendicitis can be performed without contrast for most patients; injection of contrast can be reserved for only those patients with equivocal non-contrast imaging.
磁共振成像（MRI）越来越多地被用作儿童疑似阑尾炎的诊断方法。然而，对于哪些MRI序列足以进行安全、及时和准确的诊断尚存在不确定性。最近的几项研究描述了不同的MRI方案，包括使用和不使用静脉造影剂的检查。
我们假设静脉造影剂可能对某些患者有用，但对其他患者可以安全省略。
回顾性重新评估了在我们机构进行的所有用于评估儿童阑尾炎的MRI检查（n = 112）。儿科放射科医生在三种情况下重新阅读检查：有造影剂后图像、无造影剂后图像，以及仅在诊断需要时选择性使用造影剂后序列（无/有）。样本被评为阑尾炎阳性、阴性或可疑。将结果与病历中的病理或临床随访结果进行比较。
与使用造影剂（3.4%）相比，不使用静脉造影剂产生的可疑结果更多（12.4%）。通过选择性使用造影剂后序列，无/有组产生的可疑结果（1.1%）比无造影剂组少，同时与使用造影剂组相比，造影剂使用量减少了79.8%。三组之间在条件敏感性或条件特异性方面未检测到显著差异。
大多数患者的急性阑尾炎MRI诊断无需造影剂即可进行；造影剂注射可仅保留给那些非造影成像可疑的患者。
