title: 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.
  
  
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: 1 Department of Radiology, Columbia University Medical Center, New York, NY.
authors.forename: Lucila A
authors.initials: LA
authors.lastname: Rosines
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Chow
authors.forename: Brooke S
authors.initials: BS
authors.lastname: Lampl
authors.forename: Susie
authors.initials: S
authors.lastname: Chen
authors.forename: Samantha
authors.initials: S
authors.lastname: Gordon
authors.forename: Leonora W
authors.initials: LW
authors.lastname: Mui
authors.forename: Gudrun
authors.initials: G
authors.lastname: Aspelund
authors.forename: Carrie B
authors.initials: CB
authors.lastname: Ruzal-Shapiro
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000465:Algorithms; D001064:Appendicitis / Q000473:pathology*; D002648:Child; D003287:Contrast Media; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008536:Meglumine / Q000031:analogs & derivatives*; D009942:Organometallic Compounds; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D055815:Young Adult
chemical_list: D003287:Contrast Media; D009942:Organometallic Compounds; C064572:gadobenic acid; D008536:Meglumine
keywords: MRI; acute appendicitis; gadolinium-enhanced imaging