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Society for Pediatric Radiology – Poster Archive
Final ID: Paper #: 096
Accuracy of Resident and Attending radiologist interpretations of abdominopelvic magnetic resonance imaging performed for pediatric acute appendicitis
Purpose or Case Report: Acute appendicitis represents an important cause of abdominal pain in pediatric patients. Although imaging plays an increasingly important role in the rapid diagnosis and management of this condition, there is no universally accepted strategy for imaging children suspected of having acute appendicitis. Ultrasound and computed tomography have been used most commonly, but there is rising interest in the use of magnetic resonance imaging (MRI) due to its lack of ionizing radiation or need for intravenous contrast. Recent research has shown that MRI has high diagnostic performance when employed as a first-line test. However, when considering the generalizability of MRI outside of a specialized tertiary care center, the question of operator dependence arises. To determine the performance of MRI when interpreted by readers with limited experience, we performed a retrospective review of preliminary MRI interpretations rendered by radiology residents at our institution, compared with final (attending radiologist) interpretations.
Methods & Materials: A consecutive series of 377 pediatric patients (age < 19 years) who were imaged using abdominopelvic MRI for acute abdominal pain were included. The preliminary (resident) and final (attending) interpretations of each MRI examination were reviewed and coded as positive or negative for acute appendicitis. Reference standards were derived from the electronic medical record (surgical pathology results and clinical follow-up notes). Concordance (agreement) between preliminary and final reports were determined. Additionally, diagnostic performance (sensitivity, specificity, and positive/negative predictive value) of both residents and attending radiologists were determined by comparing to the reference standards.
Results: The overall concordance rate was high (97.1%) and did not differ significantly with factors such as the PGY level of the resident or the academic year. Analysis of diagnostic performance showed a trend toward lower sensitivity in resident interpretations (91.2% vs. 97.8% for attendings). Specificity was high for both groups (97.6% and 98.9%). Positive predictive value trended lower in residents (92.2% vs. 96.7% for attendings), while negative predictive value was high for both groups (97.2% and 99.3%).
Conclusions: Trainee residents demonstrated strong diagnostic performance in the interpretation of pediatric abdominopelvic MRI, suggesting that the modality may be appropriate for broader implementation outside of specialized tertiary care centers.
Methods & Materials: A consecutive series of 377 pediatric patients (age < 19 years) who were imaged using abdominopelvic MRI for acute abdominal pain were included. The preliminary (resident) and final (attending) interpretations of each MRI examination were reviewed and coded as positive or negative for acute appendicitis. Reference standards were derived from the electronic medical record (surgical pathology results and clinical follow-up notes). Concordance (agreement) between preliminary and final reports were determined. Additionally, diagnostic performance (sensitivity, specificity, and positive/negative predictive value) of both residents and attending radiologists were determined by comparing to the reference standards.
Results: The overall concordance rate was high (97.1%) and did not differ significantly with factors such as the PGY level of the resident or the academic year. Analysis of diagnostic performance showed a trend toward lower sensitivity in resident interpretations (91.2% vs. 97.8% for attendings). Specificity was high for both groups (97.6% and 98.9%). Positive predictive value trended lower in residents (92.2% vs. 96.7% for attendings), while negative predictive value was high for both groups (97.2% and 99.3%).
Conclusions: Trainee residents demonstrated strong diagnostic performance in the interpretation of pediatric abdominopelvic MRI, suggesting that the modality may be appropriate for broader implementation outside of specialized tertiary care centers.
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Paper____096.pdf
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