Introduction: The most common cause of acute surgical abdominal pain in pediatrics is appendicitis. The clinical diagnostic scales in this age group present variable results, which may predispose to complications and that’s why imaging studies are required to make the diagnosis. Ultrasound and tomography are traditionally performed studies, however, both present important limitations in the pediatric population. Magnetic resonance imaging is postulated as an alternative, so we will seek to estimate its accuracy for the diagnosis of acute appendicitis in a pediatric population. Methods: Quantitative study of a diagnostic test in a sample of 70 patients between 4 and 17 years of age, with abdominal pain and suspected acute appendicitis at the Fundación Cardioinfantil in Bogotá D.C. MRI of the abdomen was performed without contrast, using T2 sequences with fat suppression, balanced fast field echo (BFFE) and high resolution T2. The studies were interpreted by 3 readers with different degrees of experience, who reviewed the technical quality of the MRI, the visualization of the appendix, its transverse diameter and wall thickness, the presence of appendicolith, and the association with fat alteration, free fluid or periapendicular collection. Data were analyzed using absolute and relative frequencies and sensitivity, specificity, PPV and NPV were calculated for each comparison of readings. Of the sample analyzed, 40% were taken to surgery and 60% of the patients were discharged. Results: For the diagnosis of acute appendicitis by magnetic resonance we demonstrated a sensitivity between 89.2 - 96.4%, specificity of 85.7 - 95.2%, with PPV of 75.5 - 92.5% and NPV of 91.8 - 97.3%, with a positive likelihood ratio of 4,63 to 18.7. Discussion: Magnetic resonance imaging of the abdomen is a useful tool for the diagnosis of acute appendicitis in patients between 4 and 17 years of age. Magnetic resonance imaging should be considered within the diagnostic algorithm of these patients since it does not generate exposure to ionizing radiation, the protocol does not require administration of oral or intravenous contrast medium, and the results demonstrated adequate diagnostic precision.
publication date
August 9, 2021 4:58 AM
Research
keywords
Analysis of the diagnostic recession of appendicitis using magnetic resonance imaging
Diagnostic imaging in pediatrics
Magnetic resonance imaging and exposure to ionizing radiation
Magnetic resonance imaging of the abdomen in children
