Academic radiology · 2026
MRI Interpretation of Suspected Pediatric Acute Appendicitis: The Role of Pediatric Subspecialty Training.
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Jarraya Hajer, Olayo Jaime Esteban, Guzman-Botero Ana Lucia, Pena-Trujillo Valeria, Gallo-Bernal Sebastian, Figueiro-Longo Maria Gabriela, Prabhakar Anand M, Shailam Randheer, Gee Michael S, Victoria Teresa
Аннотация
RATIONALE AND OBJECTIVES: Magnetic resonance diagnosis of pediatric acute appendicitis is highly accurate but may vary depending on reader training and subspecialty expertise. The study aims to compare the diagnostic performance of fellowship-trained pediatric radiologists and nonpediatric fellowship-trained emergency radiologists for non-contrast-enhanced magnetic resonance imaging (MRI) diagnosis of suspected pediatric acute appendicitis (AA).
MATERIALS AND METHODS: Retrospective, single-center study including 122 patients who underwent non-contrast-enhanced MRI for clinical concern of AA, following equivocal or inconclusive ultrasound. Reference standard based on clinical follow-up and surgical notes. Two fellowship-trained pediatric radiologists and two nonpediatric fellowship-trained emergency radiologists independently reviewed the examinations using a standardized yes/no case report form. Paired comparisons used McNemar's test. Predictive values are reported descriptively with 95% confidence intervals, with between-groups differences assessed using case-level bootstrap resampling. Appendix visualization was analyzed descriptively only.
RESULTS: The cohort included 122 patients (63 male [51.6%], 59 female [48.4%]; median age 11 years, IQR 7-13 years, range 4-18 years), of whom 31 (25.4%) had pathology-confirmed AA. Sensitivity for MRI diagnosis of AA was similar between groups (fellowship-trained pediatric 87.1% [71.1-94.9] vs nonpediatric fellowship-trained 90.3% [75.1-96.7]; P = 1.00), with higher specificity among pediatric radiologists (97.8% [92.3-99.4] vs 84.6% [75.8-90.6]; P = 0.002). Specificity was also higher among pediatric radiologists for direct signs (98.9% [94.0-99.8] vs 86.8% [78.4-92.3]; P = 0.001) and for combined direct and indirect signs (98.9% vs 92.3%; P = 0.03), as was accuracy for MRI diagnosis of AA (95.1% [89.7-97.7] vs 86.1% [78.8-91.1]; P = 0.03) and for direct signs (94.3% vs 86.1%; P = 0.03). Positive predictive value was higher among pediatric radiologists for the diagnosis of AA, direct signs, and combined direct and indirect signs, reaching 96.2% (81.1-99.3) vs 68.4% (52.5-80.9) for direct signs (P < 0.001). Negative predictive value did not differ in any category. Interpretation time was longer for pediatric radiologists, with a median paired difference of 23.5 seconds (P = 0.04).
CONCLUSION: Fellowship-trained pediatric radiologists had higher specificity, positive predictive value, and accuracy than non-pediatric emergency radiologists for MRI diagnosis of suspected pediatric AA, with a small difference in interpretation time (median, 24 seconds). These findings, based on a limited number of readers, suggest differences in subspecialty expertise and aims and support further multicenter evaluation.
MATERIALS AND METHODS: Retrospective, single-center study including 122 patients who underwent non-contrast-enhanced MRI for clinical concern of AA, following equivocal or inconclusive ultrasound. Reference standard based on clinical follow-up and surgical notes. Two fellowship-trained pediatric radiologists and two nonpediatric fellowship-trained emergency radiologists independently reviewed the examinations using a standardized yes/no case report form. Paired comparisons used McNemar's test. Predictive values are reported descriptively with 95% confidence intervals, with between-groups differences assessed using case-level bootstrap resampling. Appendix visualization was analyzed descriptively only.
RESULTS: The cohort included 122 patients (63 male [51.6%], 59 female [48.4%]; median age 11 years, IQR 7-13 years, range 4-18 years), of whom 31 (25.4%) had pathology-confirmed AA. Sensitivity for MRI diagnosis of AA was similar between groups (fellowship-trained pediatric 87.1% [71.1-94.9] vs nonpediatric fellowship-trained 90.3% [75.1-96.7]; P = 1.00), with higher specificity among pediatric radiologists (97.8% [92.3-99.4] vs 84.6% [75.8-90.6]; P = 0.002). Specificity was also higher among pediatric radiologists for direct signs (98.9% [94.0-99.8] vs 86.8% [78.4-92.3]; P = 0.001) and for combined direct and indirect signs (98.9% vs 92.3%; P = 0.03), as was accuracy for MRI diagnosis of AA (95.1% [89.7-97.7] vs 86.1% [78.8-91.1]; P = 0.03) and for direct signs (94.3% vs 86.1%; P = 0.03). Positive predictive value was higher among pediatric radiologists for the diagnosis of AA, direct signs, and combined direct and indirect signs, reaching 96.2% (81.1-99.3) vs 68.4% (52.5-80.9) for direct signs (P < 0.001). Negative predictive value did not differ in any category. Interpretation time was longer for pediatric radiologists, with a median paired difference of 23.5 seconds (P = 0.04).
CONCLUSION: Fellowship-trained pediatric radiologists had higher specificity, positive predictive value, and accuracy than non-pediatric emergency radiologists for MRI diagnosis of suspected pediatric AA, with a small difference in interpretation time (median, 24 seconds). These findings, based on a limited number of readers, suggest differences in subspecialty expertise and aims and support further multicenter evaluation.