The Journal of emergency medicine · 2026
Magnetic Resonance Imaging for Pediatric Appendicitis: Utilization Patterns to Guide Future Imaging Strategies.
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Pantano Sophia M, Marten Andrew D, Krauss Jillian R, Griffin Lindsay M
Аннотация
BACKGROUND: Ultrasound (US) is currently the primary modality for assessing acute appendicitis in children. However, as rapid abdominal magnetic resonance imaging (MRI) protocols become more readily available, using MRI as a first-line modality in certain patients may decrease the need for additional studies and reduce time to diagnosis.
OBJECTIVE: This study evaluates imaging utilization patterns for suspected appendicitis at a large pediatric emergency department and identifies clinical scenarios where MRI may serve as a more efficient first-line imaging modality.
METHODS: We retrospectively analyzed 5856 pediatric and young adult patients who underwent US, MRI, or both for suspected appendicitis (2016-2023), focusing on imaging utilization, demographics, and examination timing.
RESULTS: US was used as the primary modality in 86% of cases, with 22% of these patients requiring subsequent MRI. 7% of patients underwent MRI first. Time from imaging order to completion was significantly longer for the US + MRI group (217.72 min) compared to US-only (101.82 min) or MRI-only (120.75 min) (p < 0.001). Age, weight, and female sex correlated with increased US examination duration (p < 0.001), whereas MRI times remained consistent. MRI use increased from day (20.3%) to evening (23.4%) to night (29.5%), while US use declined but remained the dominant modality (p < 0.001).
CONCLUSION: Nearly a quarter of patients undergoing US for appendicitis evaluation ultimately proceed to MRI, resulting in diagnostic delays. MRI may be underutilized as a first-line modality in this subset of patients.
OBJECTIVE: This study evaluates imaging utilization patterns for suspected appendicitis at a large pediatric emergency department and identifies clinical scenarios where MRI may serve as a more efficient first-line imaging modality.
METHODS: We retrospectively analyzed 5856 pediatric and young adult patients who underwent US, MRI, or both for suspected appendicitis (2016-2023), focusing on imaging utilization, demographics, and examination timing.
RESULTS: US was used as the primary modality in 86% of cases, with 22% of these patients requiring subsequent MRI. 7% of patients underwent MRI first. Time from imaging order to completion was significantly longer for the US + MRI group (217.72 min) compared to US-only (101.82 min) or MRI-only (120.75 min) (p < 0.001). Age, weight, and female sex correlated with increased US examination duration (p < 0.001), whereas MRI times remained consistent. MRI use increased from day (20.3%) to evening (23.4%) to night (29.5%), while US use declined but remained the dominant modality (p < 0.001).
CONCLUSION: Nearly a quarter of patients undergoing US for appendicitis evaluation ultimately proceed to MRI, resulting in diagnostic delays. MRI may be underutilized as a first-line modality in this subset of patients.