This prospective study compares 3 strategies for imaging suspected appendicitis. Ultrasound alone, US+conditional MRI and MRI alone. The sensitivity of MRI alone and US + conditional MRI was 100%, ultrasound alone was found to be significantly lower at 76%.
The specificity was found to be comparable among the three investigated strategies; MRI alone 89%, US + conditional MRI 80% and US alone 89%.
The study on a technical basis is quite good, with patients enrolled consecutively and prospectively. Surgical diagnosis or 3mo followup including contact of all patients primary physician was used for clinical followup. While no flowchart is provided in the text documenting the different arms it appears none were lost to followup and all 'positive' cases did proceed to surgery. The study population had a relatively high prevalence of appendicitis at 56%.
Limitations are that the US was performed by radiology residents, and the surgical management is not clear for all cases which makes assessment of the applicability of these results to different practices (such as in Canada or US) somewhat challenging, and may explain the relatively low sensitivity of US alone despite relatively high subjective quality evaluation of the US studies.
PICO Analysis:
Population: pediatric patients 4-18yo (mean 12yo)
Intervention: US alone, MRI alone or US + conditional MRI
Comparison: Surgical dx or 3mo clinical followup
Outcome: Sensitivity and Specificity
Reference:
Pubmed Full Text
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