Jaganathan Sriram,  Rowell Amy,  Ali Sumera,  Krishnan Venkatram,  Jayappa Sateesh,  Murphy Janice,  Ramakrishnaiah Raghu,  Wong Kevin,  Schmitz Kelli,  Choudhary Arabinda,  Buchmann Robert

Final Pr. ID: Poster #: EDU-032

Objectives:
Acute appendicitis is one of the common emergent indications for imaging in the hospital setting. Though ultrasound and/or CT remains the primary imaging modality, MRI with rapid sequence imaging is also gaining credence at multiple pediatric institutions to replace CT or even replacing Ultrasound in specific settings, as the first line imaging modality. Our aim in this exhibit is to present our initial experience on implementation of a limited rapid sequence MRI appendix, at our tertiary care pediatric hospital, to evaluate for acute RLQ pain. We also detail the advantages of MRI over CT scan, pitfalls of MRI, the appearance of acute appendicitis and complications including perforation/ abscess, and other pathologies, which we found on MRI during the evaluation for acute abdominal pain.
Learning points:
Our exhibit includes:
Role of MRI appendix – emerging as an alternative to CT in diagnostic dilemma and avoids radiation
Logistics of setting up MRI appendix protocol and managing expectations
Decision on when to use MRI for evaluation of suspected appendix
Describe rapid sequence tailored protocol developed at our institution
In the context of increasing supply chain disruption issues such as CT contrast shortage, the advantages and disadvantages of MRI
Normal appearance of the appendix and peri-appendiceal region
Classical appearances on MRI appendix
1. Acute Appendicitis
2. Inflammatory mass
3. Contained appendiceal perforation
4. Abscess
5. Identifying appendicolith
6. Perforated appendicitis with abscesses in extraperitoneal spaces
Alternate pathologies which we may mimic appendicitis and was identified on MRI
1. Terminal ileitis
2. Colitis
3. Ovarian pathology
Discussion:
Acute appendicitis is one of the common pathologies encountered in pediatric emergency setting and needs prompt attention. Ultrasound is the cheapest and most easily available imaging modality, but is operator dependent, and may be limited by patient body habitus, and location of the appendix. MRI is emerging as an alternative to CT in the evaluation of appendicitis in the pediatric population. Our initial experience with implementation of the MRI appendix protocol is promising in terms of acceptance by the clinical teams, image resolution, diagnostic confidence, logistical support from the administrators, sensitivity and patient outcome. We had the added benefit of being able to utilize this protocol during CT service disruptions and contrast shortage. Read More

Authors:  Jaganathan Sriram , Rowell Amy , Ali Sumera , Krishnan Venkatram , Jayappa Sateesh , Murphy Janice , Ramakrishnaiah Raghu , Wong Kevin , Schmitz Kelli , Choudhary Arabinda , Buchmann Robert

Keywords:  MRI Appendix, Rapid sequence imaging, iodinated contrast shortage