Purpose or Case Report: Appendicitis is a common cause of acute abdominal pain requiring surgery in the pediatric population. For this reason, urgent and accurate diagnosis is critical. While ultrasound is the first line diagnostic modality, MRI has emerged as an important adjunct. The purpose of this presentation is to review the use of MRI for appendicitis in Children's hospitals from the perspectives of both the radiology departments and ordering providers using existing literature.
Methods & Materials: A PubMed search utilizing the terms (MRI) AND (appendicitis) AND ("children's hospitals") was performed. Results were reviewed with specific attention to the use of MRI for appendicitis in children and variable inter-facility use.
Results: The diagnosis of appendicitis can be made on MRI using 5 or fewer sequences, often without sedation or intravenous contrast. One survey showed that only approximately half of children's hospitals perform MRI for acute appendicitis. The use of CT for suspected appendicitis decreased in the prior decade. MRI for appendicitis increased over 20-fold from 2004 to 2018. The Pediatric Surgery Quality Collaborative found that consistent availability of MRI, appropriately trained sonographers, and pediatric radiologists, adherence to protocols, culture of inter-departmental collaboration, and presence of a radiation reduction champion were factors that favored reduction of CT.
Conclusions: MRI for appendicitis remains institution-specific with access to emergent MRI as an important discriminator of use, and there is a demand for this service according to ordering providers. A likely barrier among radiology departments is the practice of maximizing outpatient studies at children's hospitals.