An implemented MRI program to eliminate radiation from the evaluation of pediatric appendicitis

作者：Kulaylat Afif N; Moore Michael M^*; Engbrecht BrettW; Brian James M; Khaku Aliasgher; Hollenbeak Christopher S; Rocourt Dorothy V; Hulse Michael A; Olympia Robert P; Santos Mary C; Methratta Sosamma T; Dillon PeterW; Cilley Robert E

来源：Journal of Pediatric Surgery, 2015, 50(8): 1359-1363.

DOI：10.1016/j.jpedsurg.2014.12.012

• Appendicitis
• Pediatric
• Children
• Radiation
• MRI

Background: Recent efforts have been directed at reducing ionizing radiation delivered by CT scans to children in the evaluation of appendicitis. MRI has emerged as an alternative diagnostic modality. The clinical outcomes associated with MRI in this setting are not well-described.
Methods: Review of a 30-month institutional experience with MRI as the primary diagnostic evaluation for suspected appendicitis (n = 510). No intravenous contrast, oral contrast, or sedation was administered. Radiologic and clinical outcomes were abstracted.
Results: MRI diagnostic characteristics were: sensitivity 96.8% (95% CI: 92.1%-99.1%), specificity 97.4% (95% CI: 95.3-98.7), positive predictive value 92.4% (95% CI: 86.5-96.3), and negative predictive value 98.9% (95% CI: 97.3%-99.7%). Radiologic time parameters included: median time from request to scan, 71 minutes (IQR: 51-102), imaging duration, 11 minutes (IQR: 8-17), and request to interpretation, 2.0 hours (IQR: 1.6-2.6). Clinical time parameters included: median time from initial assessment to admit order, 4.1 hours (IQR: 3.1-5.1), assessment to antibiotic administration 4.7 hours (IQR: 3.9-6.7), and assessment to operating room 9.1 hours (IQR: 5.8-12.7). Median length of stay was 1.2 days (range: 0.2-19.5).
Conclusion: Given the diagnostic accuracy and favorable clinical outcomes, without the potential risks of ionizing radiation, MRI may supplant the role of CT scans in pediatric appendicitis imaging.

• 出版日期2015-8