Rapid non-contrast magnetic resonance imaging for post appendectomy intra-abdominal abscess in children

Megan H. Lee, Eric P. Eutsler, Elizabeth F. Sheybani, Geetika Khanna

Research output: Contribution to journalArticle

3 Scopus citations

Abstract

Background: Acute appendicitis, especially if perforated at presentation, is often complicated by postoperative abscess formation. The detection of a postoperative abscess relies primarily on imaging. This has traditionally been done with contrast-enhanced computed tomography. Non-contrast magnetic resonance imaging (MRI) has the potential to accurately detect intra-abdominal abscesses, especially with the use of diffusion-weighted imaging (DWI). Objective: To evaluate our single-center experience with a rapid non-contrast MRI protocol evaluating post-appendectomy abscesses in children with persistent postsurgical symptoms. Materials and methods: In this retrospective, institutional review board-approved study, all patients underwent a clinically indicated non-contrast 1.5- or 3-Tesla abdomen/pelvis MRI consisting of single-shot fast spin echo, inversion recovery and DWI sequences. All MRI studies were reviewed by two blinded pediatric radiologists to identify the presence of a drainable fluid collection. Each fluid collection was further characterized as accessible or not accessible for percutaneous or transrectal drainage. Imaging findings were compared to clinical outcome. Results: Seven of the 15 patients had a clinically significant fluid collection, and 5 of these patients were treated with percutaneous drain placement or exploratory laparotomy. The other patients had a phlegmon or a clinically insignificant fluid collection and were discharged home within 48 h. Conclusion: Rapid non-contrast MRI utilizing fluid-sensitive and DWI sequences can be used to identify drainable fluid collections in post-appendectomy patients. This protocol can be used to triage patients between conservative management vs. abscess drainage without oral/intravenous contrast or exposure to ionizing radiation.

Original languageEnglish
Pages (from-to)935-941
Number of pages7
JournalPediatric radiology
Volume47
Issue number8
DOIs
StatePublished - Jul 1 2017

Keywords

  • Abdomen
  • Abscess
  • Appendectomy
  • Appendicitis
  • Children
  • Magnetic resonance imaging

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