Value of gadolinium-enhanced MRI in detection of acute appendicitis in children and adolescents

Abstract

Objective: The aim of this study was to determine both the value of gadolinium-enhanced MRI in children with suspected acute appendicitis and the best sequences for detecting acute appendicitis, to thereby decrease imaging time.

Materials and methods: This was a retrospective review of pediatric patients with suspected appendicitis who had undergone MRI at our institution between 2010 and 2011 after an indeterminate ultrasound examination. MRI examinations included T1-weighted unenhanced and contrast-enhanced, T2-weighted, and balanced steady-state free precession (SSFP) sequences in axial and coronal planes. Sequences were reviewed together and individually by five radiologists who were blinded to the final diagnosis. Radiologists were asked to score their confidence of appendicitis diagnosis using a 5-point scale. The diagnostic performance of each MR sequence was obtained by comparing the mean area under the curve (AUC) using receiver operating characteristic (ROC) analysis.

Results: A total of 49 patients with clinically suspected appendicitis were included, of whom 16 received a diagnosis of appendicitis. The mean AUCs for reviewing all sequences together, contrast-enhanced sequences alone, T2-weighted sequences alone, and balanced SSFP alone were 0.984, 0.979, 0.944, and 0.910, respectively. No significant difference was observed between reviewing all sequences together versus contrast-enhanced sequences alone (p = 0.90) and T2-weighted sequences alone (p = 0.23). A significant difference was observed between contrast-enhanced sequences and balanced SSFP (p < 0.03).

Conclusion: Gadolinium-enhanced images and T2-weighted images are most helpful in the assessment of acute appendicitis in the pediatric population. These findings have led to protocol modifications that have reduced imaging time.

Keywords: MRI; acute appendicitis; gadolinium-enhanced imaging.