title: An implemented MRI program to eliminate radiation from the evaluation of pediatric appendicitis.
abstract: 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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, The Pennsylvania State University, College of Medicine, 500 University Drive, Hershey, PA 17033-0850, USA. Electronic address: akulaylat@hmc.psu.edu.
authors.forename: Afif N
authors.initials: AN
authors.lastname: Kulaylat
authors.affiliation: Division of Pediatric Radiology, Department of Radiology, The Pennsylvania State University, College of Medicine, 500 University Drive, Hershey, PA 17033-0850, USA. Electronic address: mmoore5@hmc.psu.edu.
authors.forename: Michael M
authors.initials: MM
authors.lastname: Moore
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, The Pennsylvania State University, College of Medicine, 500 University Drive, Hershey, PA 17033-0850, USA. Electronic address: bengbrecht@hmc.psu.edu.
authors.forename: Brett W
authors.initials: BW
authors.lastname: Engbrecht
authors.affiliation: Division of Pediatric Radiology, Department of Radiology, The Pennsylvania State University, College of Medicine, 500 University Drive, Hershey, PA 17033-0850, USA. Electronic address: jbrian@hmc.psu.edu.
authors.forename: James M
authors.initials: JM
authors.lastname: Brian
authors.affiliation: The Pennsylvania State University, College of Medicine, 500 University Drive, Hershey, PA 17033-0850, USA. Electronic address: akhaku@hmc.psu.edu.
authors.forename: Aliasgher
authors.initials: A
authors.lastname: Khaku
authors.affiliation: Department of Public Health Sciences, The Pennsylvania State University, College of Medicine, 500 University Drive, Hershey, PA 17033-0850, USA. Electronic address: chollenbeak@hmc.psu.edu.
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Hollenbeak
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, The Pennsylvania State University, College of Medicine, 500 University Drive, Hershey, PA 17033-0850, USA. Electronic address: drocourt@hmc.psu.edu.
authors.forename: Dorothy V
authors.initials: DV
authors.lastname: Rocourt
authors.affiliation: Division of Pediatric Radiology, Department of Radiology, The Pennsylvania State University, College of Medicine, 500 University Drive, Hershey, PA 17033-0850, USA. Electronic address: mhulse@hmc.psu.edu.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Hulse
authors.affiliation: Department of Emergency Medicine, The Pennsylvania State University, College of Medicine, 500 University Drive, Hershey, PA 17033-0850, USA. Electronic address: rolympia@hmc.psu.edu.
authors.forename: Robert P
authors.initials: RP
authors.lastname: Olympia
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, The Pennsylvania State University, College of Medicine, 500 University Drive, Hershey, PA 17033-0850, USA. Electronic address: msantos2@hmc.psu.edu.
authors.forename: Mary C
authors.initials: MC
authors.lastname: Santos
authors.affiliation: Division of Pediatric Radiology, Department of Radiology, The Pennsylvania State University, College of Medicine, 500 University Drive, Hershey, PA 17033-0850, USA. Electronic address: smethratta@hmc.psu.edu.
authors.forename: Sosamma T
authors.initials: ST
authors.lastname: Methratta
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, The Pennsylvania State University, College of Medicine, 500 University Drive, Hershey, PA 17033-0850, USA. Electronic address: pdillon1@hmc.psu.edu.
authors.forename: Peter W
authors.initials: PW
authors.lastname: Dillon
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, The Pennsylvania State University, College of Medicine, 500 University Drive, Hershey, PA 17033-0850, USA. Electronic address: rcilley@hmc.psu.edu.
authors.forename: Robert E
authors.initials: RE
authors.lastname: Cilley
mesh_terms: D000293:Adolescent; D001064:Appendicitis / Q000175:diagnosis*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D017063:Outcome Assessment, Health Care; D015397:Program Evaluation; D000069079:Radiation Exposure / Q000517:prevention & control*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed
keywords: Appendicitis; Children; MRI; Pediatric; Radiation