Ultrasonography/mri versus ct for diagnosing appendicitis

Gudrun Aspelund, Abbey Fingeret, Erica Gross, David Kessler, Connie Keung, Arul Thirumoorthi, Pilyung Stephen Oh, Gerald Behr, Susie Chen, Brooke Lampl, William Middlesworth, Jessica Kandel, Carrie Ruzal-Shapiro

Research output: Contribution to journalArticle

79 Citations (Scopus)

Abstract

BACKGROUND: Cross-sectional imaging increases accuracy in diagnosing appendicitis. We hypothesized that a radiation-free imaging pathway of ultrasonography selectively followed by MRI would not change clinical end points compared with computed tomography (CT) for diagnosis of acute appendicitis in children. METHODS: We retrospectively reviewed children (,18 years old) who had diagnostic imaging for suspected acute appendicitis between November 2008 and October 2012. Before November 2010 CT was used as the primary imaging modality (group A); subsequently, ultrasonography was the primary imaging modality followed by MRI for equivocal findings (group B). Data collected included time from triage to imaging and treatment and results of imaging and pathology. RESULTS: Six hundred sixty-two patients had imaging for suspected appendicitis (group A = 265; group B = 397, of which 136 [51%] and 161 [41%], respectively, had positive imaging for appendicitis). Negative appendectomy rate was 2.5% for group A and 1.4% for group B. Perforation rate was similar for both groups. Time from triage to antibiotic administration and operation did not differ between groups A and B. There was higher proportion of positive imaging and appendectomies in group A and thus more negative imaging tests in group B (ultrasonography and MRI), but diagnostic accuracy of the 2 imaging pathways was similar. CONCLUSIONS: In children with suspected acute appendicitis, a radiationfree diagnostic imaging of ultrasonography selectively followed by MRI is feasible and comparable to CT, with no difference in time to antibiotic administration, time to appendectomy, negative appendectomy rate, perforation rate, or length of stay.

Original languageEnglish (US)
Pages (from-to)586-593
Number of pages8
JournalPediatrics
Volume133
Issue number4
DOIs
StatePublished - Apr 2014

Fingerprint

Appendicitis
Ultrasonography
Appendectomy
Triage
Tomography
Diagnostic Imaging
Anti-Bacterial Agents
Imaging
Length of Stay
Radiation
Pathology

Keywords

  • Appendicitis
  • Child
  • Computed tomography
  • MRI
  • Ultrasonography

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Aspelund, G., Fingeret, A., Gross, E., Kessler, D., Keung, C., Thirumoorthi, A., ... Ruzal-Shapiro, C. (2014). Ultrasonography/mri versus ct for diagnosing appendicitis. Pediatrics, 133(4), 586-593. https://doi.org/10.1542/peds.2013-2128

Ultrasonography/mri versus ct for diagnosing appendicitis. / Aspelund, Gudrun; Fingeret, Abbey; Gross, Erica; Kessler, David; Keung, Connie; Thirumoorthi, Arul; Oh, Pilyung Stephen; Behr, Gerald; Chen, Susie; Lampl, Brooke; Middlesworth, William; Kandel, Jessica; Ruzal-Shapiro, Carrie.

In: Pediatrics, Vol. 133, No. 4, 04.2014, p. 586-593.

Research output: Contribution to journalArticle

Aspelund, G, Fingeret, A, Gross, E, Kessler, D, Keung, C, Thirumoorthi, A, Oh, PS, Behr, G, Chen, S, Lampl, B, Middlesworth, W, Kandel, J & Ruzal-Shapiro, C 2014, 'Ultrasonography/mri versus ct for diagnosing appendicitis', Pediatrics, vol. 133, no. 4, pp. 586-593. https://doi.org/10.1542/peds.2013-2128
Aspelund G, Fingeret A, Gross E, Kessler D, Keung C, Thirumoorthi A et al. Ultrasonography/mri versus ct for diagnosing appendicitis. Pediatrics. 2014 Apr;133(4):586-593. https://doi.org/10.1542/peds.2013-2128
Aspelund, Gudrun ; Fingeret, Abbey ; Gross, Erica ; Kessler, David ; Keung, Connie ; Thirumoorthi, Arul ; Oh, Pilyung Stephen ; Behr, Gerald ; Chen, Susie ; Lampl, Brooke ; Middlesworth, William ; Kandel, Jessica ; Ruzal-Shapiro, Carrie. / Ultrasonography/mri versus ct for diagnosing appendicitis. In: Pediatrics. 2014 ; Vol. 133, No. 4. pp. 586-593.
@article{19fc98c61e3f46cfb7004ee919e32a49,
title = "Ultrasonography/mri versus ct for diagnosing appendicitis",
abstract = "BACKGROUND: Cross-sectional imaging increases accuracy in diagnosing appendicitis. We hypothesized that a radiation-free imaging pathway of ultrasonography selectively followed by MRI would not change clinical end points compared with computed tomography (CT) for diagnosis of acute appendicitis in children. METHODS: We retrospectively reviewed children (,18 years old) who had diagnostic imaging for suspected acute appendicitis between November 2008 and October 2012. Before November 2010 CT was used as the primary imaging modality (group A); subsequently, ultrasonography was the primary imaging modality followed by MRI for equivocal findings (group B). Data collected included time from triage to imaging and treatment and results of imaging and pathology. RESULTS: Six hundred sixty-two patients had imaging for suspected appendicitis (group A = 265; group B = 397, of which 136 [51{\%}] and 161 [41{\%}], respectively, had positive imaging for appendicitis). Negative appendectomy rate was 2.5{\%} for group A and 1.4{\%} for group B. Perforation rate was similar for both groups. Time from triage to antibiotic administration and operation did not differ between groups A and B. There was higher proportion of positive imaging and appendectomies in group A and thus more negative imaging tests in group B (ultrasonography and MRI), but diagnostic accuracy of the 2 imaging pathways was similar. CONCLUSIONS: In children with suspected acute appendicitis, a radiationfree diagnostic imaging of ultrasonography selectively followed by MRI is feasible and comparable to CT, with no difference in time to antibiotic administration, time to appendectomy, negative appendectomy rate, perforation rate, or length of stay.",
keywords = "Appendicitis, Child, Computed tomography, MRI, Ultrasonography",
author = "Gudrun Aspelund and Abbey Fingeret and Erica Gross and David Kessler and Connie Keung and Arul Thirumoorthi and Oh, {Pilyung Stephen} and Gerald Behr and Susie Chen and Brooke Lampl and William Middlesworth and Jessica Kandel and Carrie Ruzal-Shapiro",
year = "2014",
month = "4",
doi = "10.1542/peds.2013-2128",
language = "English (US)",
volume = "133",
pages = "586--593",
journal = "Pediatrics",
issn = "0031-4005",
publisher = "American Academy of Pediatrics",
number = "4",

}

TY - JOUR

T1 - Ultrasonography/mri versus ct for diagnosing appendicitis

AU - Aspelund, Gudrun

AU - Fingeret, Abbey

AU - Gross, Erica

AU - Kessler, David

AU - Keung, Connie

AU - Thirumoorthi, Arul

AU - Oh, Pilyung Stephen

AU - Behr, Gerald

AU - Chen, Susie

AU - Lampl, Brooke

AU - Middlesworth, William

AU - Kandel, Jessica

AU - Ruzal-Shapiro, Carrie

PY - 2014/4

Y1 - 2014/4

N2 - BACKGROUND: Cross-sectional imaging increases accuracy in diagnosing appendicitis. We hypothesized that a radiation-free imaging pathway of ultrasonography selectively followed by MRI would not change clinical end points compared with computed tomography (CT) for diagnosis of acute appendicitis in children. METHODS: We retrospectively reviewed children (,18 years old) who had diagnostic imaging for suspected acute appendicitis between November 2008 and October 2012. Before November 2010 CT was used as the primary imaging modality (group A); subsequently, ultrasonography was the primary imaging modality followed by MRI for equivocal findings (group B). Data collected included time from triage to imaging and treatment and results of imaging and pathology. RESULTS: Six hundred sixty-two patients had imaging for suspected appendicitis (group A = 265; group B = 397, of which 136 [51%] and 161 [41%], respectively, had positive imaging for appendicitis). Negative appendectomy rate was 2.5% for group A and 1.4% for group B. Perforation rate was similar for both groups. Time from triage to antibiotic administration and operation did not differ between groups A and B. There was higher proportion of positive imaging and appendectomies in group A and thus more negative imaging tests in group B (ultrasonography and MRI), but diagnostic accuracy of the 2 imaging pathways was similar. CONCLUSIONS: In children with suspected acute appendicitis, a radiationfree diagnostic imaging of ultrasonography selectively followed by MRI is feasible and comparable to CT, with no difference in time to antibiotic administration, time to appendectomy, negative appendectomy rate, perforation rate, or length of stay.

AB - BACKGROUND: Cross-sectional imaging increases accuracy in diagnosing appendicitis. We hypothesized that a radiation-free imaging pathway of ultrasonography selectively followed by MRI would not change clinical end points compared with computed tomography (CT) for diagnosis of acute appendicitis in children. METHODS: We retrospectively reviewed children (,18 years old) who had diagnostic imaging for suspected acute appendicitis between November 2008 and October 2012. Before November 2010 CT was used as the primary imaging modality (group A); subsequently, ultrasonography was the primary imaging modality followed by MRI for equivocal findings (group B). Data collected included time from triage to imaging and treatment and results of imaging and pathology. RESULTS: Six hundred sixty-two patients had imaging for suspected appendicitis (group A = 265; group B = 397, of which 136 [51%] and 161 [41%], respectively, had positive imaging for appendicitis). Negative appendectomy rate was 2.5% for group A and 1.4% for group B. Perforation rate was similar for both groups. Time from triage to antibiotic administration and operation did not differ between groups A and B. There was higher proportion of positive imaging and appendectomies in group A and thus more negative imaging tests in group B (ultrasonography and MRI), but diagnostic accuracy of the 2 imaging pathways was similar. CONCLUSIONS: In children with suspected acute appendicitis, a radiationfree diagnostic imaging of ultrasonography selectively followed by MRI is feasible and comparable to CT, with no difference in time to antibiotic administration, time to appendectomy, negative appendectomy rate, perforation rate, or length of stay.

KW - Appendicitis

KW - Child

KW - Computed tomography

KW - MRI

KW - Ultrasonography

UR - http://www.scopus.com/inward/record.url?scp=84898715676&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84898715676&partnerID=8YFLogxK

U2 - 10.1542/peds.2013-2128

DO - 10.1542/peds.2013-2128

M3 - Article

C2 - 24590746

AN - SCOPUS:84898715676

VL - 133

SP - 586

EP - 593

JO - Pediatrics

JF - Pediatrics

SN - 0031-4005

IS - 4

ER -