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Rodriguez-Takeuchi S, Sousa-Plata K, Man C, Vidarson L, Rayner T, Mohanta A, Amirabadi A, Schuh S, Doria AS. Characterization and quantification of fluid in the abdomen by ultrasound and magnetic resonance imaging in children with clinical suspicion of appendicitis. Abdom Radiol (NY) 2024; 49:1031-1041. [PMID: 38195800 DOI: 10.1007/s00261-023-04133-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 08/18/2023] [Accepted: 08/20/2023] [Indexed: 01/11/2024]
Abstract
PURPOSE While regarded as a secondary sign of pediatric appendicitis, the frequency of physiologic intra-abdominal fluid in children with suspected but absent appendicitis is unknown. Ex vivo: to assess the validity of US/MRI measurements of free fluid. In vivo: in suspected pediatric appendicitis, to assess the amount of abdominal fluid by US and MRI, determine performance characteristics of US in fluid detection and identify fluid volume ranges in confirmed appendicitis. METHODS Ex vivo: criterion validity of US and MRI for fluid volume measurements was tested using tissue-mimicking phantoms filled with different volumes of distilled water. In vivo: all participants from a previous prospective study of suspected appendicitis were evaluated by US; MRI was performed after equivocal USs. Qualitative and quantitative analyses of abdominal fluid and correlation of fluid presence with appendicitis were performed. RESULTS Ex vivo: no difference was found between phantom-fluid amount and measured volume using the formula for volume of an ellipsoid for US (P=0.19) or MRI (P=0.08). In vivo: intra-abdominal fluid was present in 212/591 (35.9%) patients; 75/212 patients with fluid (35.4%) had appendicitis, 60 (28.3%) had alternate diagnoses, and 77 (36.3%) had physiologic fluid. Sensitivity and specificity of US for fluid detection were 84% (95% CI 71-93) and 65% (95% CI 52-77), respectively. In children with versus without appendicitis, the respective ranges of fluid volume were 0.7-1148.8 ml and 0.8-318 ml. CONCLUSION The volume of an ellipsoid formula is a valid method for quantifying intra-abdominal fluid. The sole presence of intra-abdominal fluid on US does not support the diagnosis of pediatric appendicitis.
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Affiliation(s)
- Sara Rodriguez-Takeuchi
- Department of Diagnostic Imaging and Research Institute, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada
- Emergency Department, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada
- Department of Diagnostic Imaging, Fundacion Valle de Lili, Cali, Colombia
| | - Karen Sousa-Plata
- Department of Diagnostic Imaging and Research Institute, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada
- Emergency Department, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada
| | - Carina Man
- Department of Diagnostic Imaging and Research Institute, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada
- Emergency Department, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada
| | - Logi Vidarson
- Department of Diagnostic Imaging and Research Institute, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada
- Emergency Department, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada
| | - Tammy Rayner
- Department of Diagnostic Imaging and Research Institute, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada
- Emergency Department, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada
| | - Arun Mohanta
- Department of Diagnostic Imaging and Research Institute, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada
- Emergency Department, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada
| | - Afsaneh Amirabadi
- Department of Diagnostic Imaging and Research Institute, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada
- Emergency Department, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada
| | - Suzanne Schuh
- Department of Diagnostic Imaging and Research Institute, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada
- Emergency Department, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada
| | - Andrea S Doria
- Department of Diagnostic Imaging and Research Institute, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada.
- Emergency Department, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada.
- Department of Medical Imaging, University of Toronto, Toronto, ON, M5G 1X8, Canada.
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Holguin AJ, Rodriguez-Takeuchi S, Ospina L, Acosta D, Botero V, Thomas L, Villegas J, Echeverry GJ, Caicedo L. Biliary strictures complicating liver transplantation in pediatric patients: Experience in a South American transplant center. Clin Transplant 2017; 31. [DOI: 10.1111/ctr.12877] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2016] [Indexed: 12/21/2022]
Affiliation(s)
- Alfonso J. Holguin
- Department of Radiology; Fundación Valle de Lili; Cali Colombia
- ICESI University; Cali Colombia
- Centro de Investigaciones Clínicas; Fundación Valle de Lili; Cali Colombia
| | - Sara Rodriguez-Takeuchi
- Department of Radiology; Fundación Valle de Lili; Cali Colombia
- ICESI University; Cali Colombia
- Centro de Investigaciones Clínicas; Fundación Valle de Lili; Cali Colombia
| | - Laura Ospina
- Department of Radiology; Fundación Valle de Lili; Cali Colombia
- ICESI University; Cali Colombia
- Centro de Investigaciones Clínicas; Fundación Valle de Lili; Cali Colombia
| | - Diana Acosta
- Department of Radiology; Fundación Valle de Lili; Cali Colombia
| | - Veronica Botero
- ICESI University; Cali Colombia
- Centro de Investigaciones Clínicas; Fundación Valle de Lili; Cali Colombia
- Department of Pediatrics; Fundación Valle de Lili; Cali Colombia
| | - Laura Thomas
- Centro de Investigaciones Clínicas; Fundación Valle de Lili; Cali Colombia
- Division of Organ Transplantation; Department of Surgery; Fundación Valle de Lili; Cali Colombia
- Centro Para la Investigación en Cirugía Avanzada y Trasplantes; CICAT; Cali Colombia
| | - Jorge Villegas
- ICESI University; Cali Colombia
- Centro de Investigaciones Clínicas; Fundación Valle de Lili; Cali Colombia
- Division of Organ Transplantation; Department of Surgery; Fundación Valle de Lili; Cali Colombia
- Centro Para la Investigación en Cirugía Avanzada y Trasplantes; CICAT; Cali Colombia
| | - Gabriel J. Echeverry
- ICESI University; Cali Colombia
- Centro de Investigaciones Clínicas; Fundación Valle de Lili; Cali Colombia
- Division of Organ Transplantation; Department of Surgery; Fundación Valle de Lili; Cali Colombia
- Centro Para la Investigación en Cirugía Avanzada y Trasplantes; CICAT; Cali Colombia
| | - Luis Caicedo
- ICESI University; Cali Colombia
- Centro de Investigaciones Clínicas; Fundación Valle de Lili; Cali Colombia
- Division of Organ Transplantation; Department of Surgery; Fundación Valle de Lili; Cali Colombia
- Centro Para la Investigación en Cirugía Avanzada y Trasplantes; CICAT; Cali Colombia
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