title: Harmonic US imaging of appendicitis in children.
abstract: BACKGROUND
  Harmonic imaging (HI), a relatively new ultrasound modality, was initially reported to be of use only in obese adult patients. HI increases the contrast and spatial resolution resulting in artefact-free images, and has been shown in adults to significantly improve abdominal sonography. Regarding its application in paediatric patients, just a handful reports exist and these do not encompass its use in intestinal sonography.
  
  
  OBJECTIVE
  To compare the sonomorphological image quality of HI and fundamental imaging (FI, conventional grey-scale imaging) in the diagnosis of histologically confirmed appendicitis in children.
  
  
  METHODS
  For this prospective comparative study, 50 children (male/female 25/25; mean age 9.9 years) suspected of having appendicitis were recruited. In all patients US examination of the appendix and periappendiceal region was performed preoperatively and appendectomy carried out. The final diagnosis was based on histological examination of the appendix. Both FI and HI were used in the US examination (tissue harmonic imaging, THI; Sonoline Elegra, Siemens; 7.5 MHz linear transducer). A detailed comparison of the images from FI and HI was performed using a scoring system. The parameters compared included delineation of the appendiceal contour, wall, mucosa, contents of the appendix and surrounding tissues. Furthermore, periappendiceal findings such as mesenteric echogenicity, free fluid, lymph nodes and adjacent bowel wall thickening were compared.
  
  
  RESULTS
  In 43 children (86%) acute appendicitis was histologically confirmed. The inflamed appendix could be depicted in the HI and FI modes in 93% and 86%, respectively. HI was found to be significantly better for the depiction of the outer contour, wall, mucosa and contents of the appendix (P<0.01). This was also true for the demonstration of free fluid, mesenteric lymph nodes, adjacent bowel walls and mesenteric echogenicity.
  
  
  CONCLUSIONS
  HI should be the preferred modality for scanning the right lower abdomen in suspected acute appendicitis. The diagnosis of acute appendicitis can then be more definitely ascertained.
authors.affiliation: Division of Paediatric Radiology, Institute of Diagnostic and Interventional Radiology, Klinikum Nürnberg Süd, Nuremberg, Germany. oliver.rompel@klinikum-nuernberg.de
authors.forename: Oliver
authors.initials: O
authors.lastname: Rompel
authors.forename: Birgit
authors.initials: B
authors.lastname: Huelsse
authors.forename: Karl
authors.initials: K
authors.lastname: Bodenschatz
authors.forename: Gert
authors.initials: G
authors.lastname: Reutter
authors.forename: Kassa
authors.initials: K
authors.lastname: Darge
mesh_terms: D000293:Adolescent; D001064:Appendicitis / Q000175:diagnosis*; D001065:Appendix / Q000000981:diagnostic imaging*; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D015588:Observer Variation; D011446:Prospective Studies; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014463:Ultrasonography