title: Equivocal Pediatric Appendicitis: Unenhanced MR Imaging Protocol for Nonsedated Children-A Clinical Effectiveness Study.
abstract: OBJECTIVE
  To determine retrospectively the clinical effectiveness of an unenhanced magnetic resonance (MR) imaging protocol for evaluation of equivocal appendicitis in children.
  
  
  METHODS
  Institutional review board approval was obtained. Pediatric patients (≤18 years old) underwent unenhanced MR imaging and contrast material-enhanced computed tomography (CT) of the appendix between December 2013 and November 2014 and December 2012 and November 2013, respectively, within 24 hours after an abdominal ultrasonographic examination with results equivocal for appendicitis. Pertinent MR imaging and CT reports were reviewed for visibility of the appendix, presence of appendicitis and appendiceal perforation, and establishment of an alternative diagnosis. Surgical reports, pathologic reports, and 30-day follow-up medical records were used as reference standards. Diagnostic performance with MR imaging and CT was calculated with 95% confidence intervals (CIs) for diagnosis of appendicitis and appendiceal perforation. The Fisher exact test was used to compare proportions; the Student t test was used to compare means.
  
  
  RESULTS
  Diagnostic performance with MR imaging was comparable to that with CT for equivocal pediatric appendicitis. For MR imaging (n = 103), sensitivity was 94.4% (95% CI: 72.7%, 99.9%) and specificity was 100% (95% CI: 95.8%, 100%); for CT [n = 58], sensitivity was 100% (95% CI: 71.5%, 100%), specificity was 97.9% (95% CI: 88.7%, 100%). Diagnostic performance with MR imaging and CT also was comparable for detection of appendiceal perforation, with MR imaging (n = 103) sensitivity of 90.0% (95% CI: 55.5%, 99.8%) and specificity of 85.7% (95% CI: 42.1%, 99.6%) and CT (n = 58) sensitivity of 75.0% (95% CI: 19.4%, 99.4%) and specificity of 85.7% (95% CI: 42.1%, 99.6%). The proportion of examinations with identifiable alternative diagnoses was similar at MR imaging to that at CT (19 of 103 [18.4%] vs eight of 58 [13.8%], respectively; P = .52). The proportion of appendixes seen at MR imaging and at CT also was similar (77 of 103 [74.8%] vs 50 of 58 [86.2%], respectively; P = .11).
  
  
  CONCLUSIONS
  Unenhanced MR imaging is sensitive and specific for the diagnosis of equivocal appendicitis in nonsedated pediatric patients.
authors.affiliation: From the Section of Pediatric Radiology, Department of Radiology (J.R.D., E.A.S., P.J.S.), Section of Pediatric Surgery, Department of Surgery (S.G.), Children's Emergency Services, Department of Emergency Medicine (N.S.S.), Division of Abdominal Imaging, Department of Radiology (M.S.D.), and Division of Emergency Radiology, Department of Radiology (S.T.C., M.B.M.), University of Michigan Health System, 1540 E Hospital Dr, Ann Arbor, MI 48109.
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Dillman
authors.affiliation: From the Section of Pediatric Radiology, Department of Radiology (J.R.D., E.A.S., P.J.S.), Section of Pediatric Surgery, Department of Surgery (S.G.), Children's Emergency Services, Department of Emergency Medicine (N.S.S.), Division of Abdominal Imaging, Department of Radiology (M.S.D.), and Division of Emergency Radiology, Department of Radiology (S.T.C., M.B.M.), University of Michigan Health System, 1540 E Hospital Dr, Ann Arbor, MI 48109.
authors.forename: Samir
authors.initials: S
authors.lastname: Gadepalli
authors.affiliation: From the Section of Pediatric Radiology, Department of Radiology (J.R.D., E.A.S., P.J.S.), Section of Pediatric Surgery, Department of Surgery (S.G.), Children's Emergency Services, Department of Emergency Medicine (N.S.S.), Division of Abdominal Imaging, Department of Radiology (M.S.D.), and Division of Emergency Radiology, Department of Radiology (S.T.C., M.B.M.), University of Michigan Health System, 1540 E Hospital Dr, Ann Arbor, MI 48109.
authors.forename: Nicole S
authors.initials: NS
authors.lastname: Sroufe
authors.affiliation: From the Section of Pediatric Radiology, Department of Radiology (J.R.D., E.A.S., P.J.S.), Section of Pediatric Surgery, Department of Surgery (S.G.), Children's Emergency Services, Department of Emergency Medicine (N.S.S.), Division of Abdominal Imaging, Department of Radiology (M.S.D.), and Division of Emergency Radiology, Department of Radiology (S.T.C., M.B.M.), University of Michigan Health System, 1540 E Hospital Dr, Ann Arbor, MI 48109.
authors.forename: Matthew S
authors.initials: MS
authors.lastname: Davenport
authors.affiliation: From the Section of Pediatric Radiology, Department of Radiology (J.R.D., E.A.S., P.J.S.), Section of Pediatric Surgery, Department of Surgery (S.G.), Children's Emergency Services, Department of Emergency Medicine (N.S.S.), Division of Abdominal Imaging, Department of Radiology (M.S.D.), and Division of Emergency Radiology, Department of Radiology (S.T.C., M.B.M.), University of Michigan Health System, 1540 E Hospital Dr, Ann Arbor, MI 48109.
authors.forename: Ethan A
authors.initials: EA
authors.lastname: Smith
authors.affiliation: From the Section of Pediatric Radiology, Department of Radiology (J.R.D., E.A.S., P.J.S.), Section of Pediatric Surgery, Department of Surgery (S.G.), Children's Emergency Services, Department of Emergency Medicine (N.S.S.), Division of Abdominal Imaging, Department of Radiology (M.S.D.), and Division of Emergency Radiology, Department of Radiology (S.T.C., M.B.M.), University of Michigan Health System, 1540 E Hospital Dr, Ann Arbor, MI 48109.
authors.forename: Suzanne T
authors.initials: ST
authors.lastname: Chong
authors.affiliation: From the Section of Pediatric Radiology, Department of Radiology (J.R.D., E.A.S., P.J.S.), Section of Pediatric Surgery, Department of Surgery (S.G.), Children's Emergency Services, Department of Emergency Medicine (N.S.S.), Division of Abdominal Imaging, Department of Radiology (M.S.D.), and Division of Emergency Radiology, Department of Radiology (S.T.C., M.B.M.), University of Michigan Health System, 1540 E Hospital Dr, Ann Arbor, MI 48109.
authors.forename: Michael B
authors.initials: MB
authors.lastname: Mazza
authors.affiliation: From the Section of Pediatric Radiology, Department of Radiology (J.R.D., E.A.S., P.J.S.), Section of Pediatric Surgery, Department of Surgery (S.G.), Children's Emergency Services, Department of Emergency Medicine (N.S.S.), Division of Abdominal Imaging, Department of Radiology (M.S.D.), and Division of Emergency Radiology, Department of Radiology (S.T.C., M.B.M.), University of Michigan Health System, 1540 E Hospital Dr, Ann Arbor, MI 48109.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Strouse
mesh_terms: D001064:Appendicitis / Q000175:diagnosis*; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed