Department of Medical Imaging, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.
Faculty of Medicine, McMaster University, Hamilton, Ontario, Canada.
J Magn Reson Imaging. 2019 Jun;49(7):e241-e249. doi: 10.1002/jmri.26624. Epub 2019 Jan 4.
Noncontrast MRI has been shown to be feasible in children with postappendectomy abscesses and helps guide clinical management, but its role in preoperative appendiceal abscesses is unclear.
To determine the cost-effectiveness and impact on clinical management of noncontrast MRI in pediatric patients with suspected appendiceal abscess, both pre- and postappendectomy.
Retrospective cohort study.
In all, 82 children under the age of 18 years with suspected appendiceal abscess on ultrasound.
FIELD STRENGTH/SEQUENCE: Diffusion-weighted imaging and T -weighted single-shot fast spin-echo imaging of the abdomen and pelvis at 1.5T and 3T.
The presence, location, size, and apparent diffusion coefficient (ADC) of fluid collections and the presence of a drainage path was noted by three pediatric radiologists. Imaging time, completeness of the exam, and impact on clinical management was recorded. The incremental cost-effectiveness ratio was calculated for MRI relative to CT, taking into account hospital charges, radiation exposure, and risk of adverse reaction to iodinated contrast.
Descriptive statistics were used. Intraclass correlation coefficient and Fleiss' kappa were used to assess interobserver variation. Proportions were compared using Fisher's exact test (statistical significance at P < 0.05).
MRI confirmed the presence of collections in most cases, with alternative diagnosis established in 10 patients (Tubo-ovarian abscess n = 7, Crohn's disease, ileal anastomotic leak, and Birkitts lymphoma each n = 1). MRI showed the presence of a safe drainage pathway in 92-97% of pelvic abscesses and 86-98% of abdominal abscesses compared with 7-10% and 75-81%, respectively, for ultrasound. MR was cost-effective compared with CT, taking into account the direct charges, risk of radiation induced cancer, and adverse reaction to iodinated contrast.
Noncontrast MR is cost-effective and affects clinical management in a significant proportion of children with suspected appendiceal abscesses.
5 Technical Efficacy: Stage 6 J. Magn. Reson. Imaging 2019.
非对比 MRI 已被证明在阑尾切除术后脓肿的儿童中是可行的，有助于指导临床管理，但在术前阑尾脓肿中的作用尚不清楚。
确定非对比 MRI 在疑似阑尾脓肿的儿科患者中的成本效益和对临床管理的影响，包括阑尾切除术前和术后。
回顾性队列研究。
所有年龄在 18 岁以下的经超声检查怀疑阑尾脓肿的儿童。
场强/序列：腹部和骨盆的弥散加权成像和 T1 加权单次快速自旋回波成像，场强分别为 1.5T 和 3T。
三位儿科放射科医生记录了液体收集物的存在、位置、大小和表观扩散系数（ADC）以及引流路径的存在。记录了成像时间、检查的完整性以及对临床管理的影响。考虑到医院收费、辐射暴露和对碘造影剂不良反应的风险，计算了 MRI 相对于 CT 的增量成本效益比。
使用描述性统计。使用组内相关系数和 Fleiss' kappa 评估观察者间的变异。使用 Fisher 确切检验比较比例（统计学意义 P < 0.05）。
MRI 在大多数情况下证实了脓肿的存在，在 10 例患者中建立了替代诊断（卵巢脓肿 7 例，克罗恩病、回肠吻合口漏和 Birkitts 淋巴瘤各 1 例）。与超声相比，MRI 显示在 92-97%的盆腔脓肿和 86-98%的腹腔脓肿中存在安全的引流途径，而超声分别为 7-10%和 75-81%。考虑到直接费用、辐射诱导癌症的风险以及对碘造影剂的不良反应，MRI 与 CT 相比具有成本效益。
非对比 MRI 在疑似阑尾脓肿的儿童中具有成本效益，并在很大程度上影响临床管理。
5 技术功效：第 6 阶段 J. 磁共振成像 2019 年。
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