Komanchuk Jelena, Martin Dori-Ann, Killam Rory, Eccles Robin, Brindle Mary E, Khanafer Ijab, Joffe Ari R, Blackwood Jaime, Yu Weiming, Gupta Priya, Sethi Sanjay, Moorjani Vijay, Thompson Graham
Faculty of Nursing, 2129University of Calgary, Calgary, Alberta, Canada.
Department of Pediatrics, 2129University of Calgary, Calgary, Alberta, Canada.
Can Assoc Radiol J. 2021 Nov;72(4):797-805. doi: 10.1177/0846537121993797. Epub 2021 Mar 1.
In Canada, ultrasonography is the primary imaging modality for children with suspected appendicitis, yet equivocal studies are common. Magnetic resonance imaging provides promise as an adjunct imaging strategy. The primary objective of this study was to determine the proportion of children with suspected appendicitis and equivocal ultrasound where magnetic resonance imaging determined a diagnosis.
A prospective consecutive cohort of children aged 5-17 years presenting to a tertiary pediatric Emergency Department with suspected appendicitis were enrolled. Participants underwent diagnostic and management strategies according to our local suspected appendicitis pathway, followed by magnetic resonance (Siemens Avanto 1.5 Tesla) imaging. Sub-specialty pediatric radiologists reported all images.
Magnetic resonance imaging was performed in 101 children with suspected appendicitis. The mean age was 11.9 (SD 3.4) years and median Pediatric Appendicitis Score was 6 [IQR 4,8]. Ultrasonography was completed in 98/101 (97.0%). Of 53/98 (54.1%) with equivocal ultrasound, magnetic resonance imaging provided further diagnostic information in 41 (77.4%; 10 positive, 31 negative; 12 remained equivocal). Secondary findings of appendicitis on magnetic resonance imaging in children with equivocal ultrasound included abdominal free fluid (24, 45.3%), peri-appendiceal fluid (12, 22.6%), intraluminal appendiceal fluid (9, 17.0%), fat stranding (8, 15.1%), appendicolith (2, 3.8%), and peri-appendiceal abscess (1, 1.9%). The observed agreement between magnetic resonance imaging results and final diagnosis was 94.9% (kappa = 0.89).
在加拿大，超声检查是疑似阑尾炎儿童的主要成像方式，但检查结果不明确的情况很常见。磁共振成像有望成为一种辅助成像策略。本研究的主要目的是确定在超声检查结果不明确的疑似阑尾炎儿童中，通过磁共振成像明确诊断的比例。
纳入了一组前瞻性连续队列，这些5至17岁疑似阑尾炎并前往三级儿科急诊科就诊的儿童。参与者按照我们当地疑似阑尾炎的诊疗流程接受诊断和管理策略，随后进行磁共振（西门子Avanto 1.5特斯拉）成像。儿科亚专业放射科医生报告所有图像。
对101名疑似阑尾炎儿童进行了磁共振成像检查。平均年龄为11.9（标准差3.4）岁，儿童阑尾炎评分中位数为6[四分位间距4,8]。98/101（97.0%）完成了超声检查。在53/98（54.1%）超声检查结果不明确的患儿中，磁共振成像提供了进一步诊断信息的有41例（77.4%；10例阳性，31例阴性；12例仍不明确）。超声检查结果不明确的儿童磁共振成像显示的阑尾炎次要表现包括腹腔游离液体（24例，45.3%）、阑尾周围液体（12例，22.6%）、阑尾腔内液体（9例，17.0%）、脂肪条纹（8例，15.1%）、阑尾结石（2例，3.8%）和阑尾周围脓肿（1例，1.9%）。磁共振成像结果与最终诊断之间的观察一致性为94.9%（kappa = 0.89）。
