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Abdominal Radiology

, Volume 44, Issue 1, pp 22–30 | Cite as

Conical ultrashort echo time (UTE) MRI in the evaluation of pediatric acute appendicitis

  • Albert T. Roh
  • Zhibo Xiao
  • Joseph Y. Cheng
  • Shreyas S. Vasanawala
  • Andreas M. LoeningEmail author
Article

Abstract

Purpose

Magnetic resonance imaging (MRI) sequences with conical k-space trajectories are able to decrease motion artifacts while achieving ultrashort echo times (UTE). We assessed the performance of free-breathing conical UTE MRI in the evaluation of the pediatric pelvis for suspected appendicitis.

Methods

Our retrospective review of 84 pediatric patients who underwent MRI for suspected appendicitis compared three contrast-enhanced sequences: free-breathing conical UTE, breath-hold three-dimensional (3D) spoiled gradient echo (BH-SPGR), and free-breathing high-resolution 3D SPGR (FB-SPGR). Two radiologists performed blinded and independent evaluations of each sequence for image quality (four point scale), anatomic delineation (four point scale), and diagnostic confidence (five point scale). Subsequently, the three sequences were directly compared for overall image quality (− 3 to + 3 scale). Scores were compared using Kruskal–Wallis and Wilcoxon signed-rank tests.

Results

UTE demonstrated significantly better perceived signal-to-noise ratio (SNR) and fewer artifacts than BH-SPGR and FB-SPGR (means of 3.6 and 3.4, 3.4 and 3.2, 3.1 and 2.7, respectively; p < 0.0006). BH-SPGR and FB-SPGR demonstrated significantly better contrast than UTE (means of 3.6, 3.4, and 3.2, respectively; p < 0.03). In the remaining categories, UTE performed significantly better than FB-SPGR (p < 0.00001), while there was no statistical difference between UTE and BH-SPGR. Direct paired comparisons of overall image quality demonstrated the readers significantly preferred UTE over both BH-SPGR (mean + 0.5, p < 0.00001) and FB-SPGR (mean + 1.2, p < 0.00001).

Conclusions

In the evaluation of suspected appendicitis, free-breathing conical UTE MRI performed better in the assessed metrics than FB-SPGR. When compared to BH-SPGR, UTE demonstrated superior perceived SNR and fewer artifacts.

Keywords

Ultrashort echo time Non-Cartesian Pediatric Appendicitis Pelvis 

Notes

Compliance with ethical standards

Funding

This study was funded by NIBIB R01EB009690.

Conflict of interest

Albert T. Roh, Zhibo Xiao, Joseph Y. Cheng, and Andreas M. Loening declare that they have no conflict of interest. Shreyas S. Vasanawala has received grant support from NIBIB R09EB009690.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Institutional Research Committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

References

  1. 1.
    Doria AS, Moineddin R, Kellenberger CJ, et al. (2006) US or CT for diagnosis of appendicitis in children and adults? A meta-analysis. Radiology 241:83–94CrossRefGoogle Scholar
  2. 2.
    Garcia Pena BM, Mandl KD, Kraus SJ, et al. (1999) Ultrasonography and limited computed tomography in the diagnosis and management of appendicitis in children. JAMA 282:1041–1046CrossRefGoogle Scholar
  3. 3.
    Rothrock SG, Pagane J (2000) Acute appendicitis in children: emergency department diagnosis and management. Ann Emerg Med 36:39–51CrossRefGoogle Scholar
  4. 4.
    Wan MJ, Krahn M, Ungar WJ, et al. (2009) Acute appendicitis in young children: cost-effectiveness of US versus CT in diagnosis—a Markov decision analytic model. Radiology 250:378–386CrossRefGoogle Scholar
  5. 5.
    Brenner DJ, Hall EJ (2007) Computed tomography—an increasing source of radiation exposure. N Engl J Med 357:2277–2284CrossRefGoogle Scholar
  6. 6.
    Brody AS, Frush DP, Huda W, et al. (2007) Radiation risk to children from computed tomography. Pediatrics 120:677–682CrossRefGoogle Scholar
  7. 7.
    Callahan MJ (2011) CT dose reduction in practice. Pediatr Radiol 41:488–492CrossRefGoogle Scholar
  8. 8.
    Macdougall RD, Strauss KJ, Lee EY (2013) Managing radiation dose from thoracic multidetector computed tomography in pediatric patients: background, current issues, and recommendations. Radiol Clin N Am 51:743–760CrossRefGoogle Scholar
  9. 9.
    Pearce MS, Salotti JA, Little MP, et al. (2012) Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study. Lancet 380:499–505CrossRefGoogle Scholar
  10. 10.
    Sivit CJ, Applegate KE, Berlin SC, et al. (2000) Evaluation of suspected appendicitis in children and young adults: helical CT. Radiology 216:430–433CrossRefGoogle Scholar
  11. 11.
    Slovis TL, Berdon WE (2002) The ALARA concept in pediatric CT intelligent dose reduction. Pediatr Radiol 32:217–317CrossRefGoogle Scholar
  12. 12.
    Verdun FR, Bochud F, Gudinchet F, et al. (2008) Quality initiatives radiation risk: what you should know to tell your patient. RadioGraphics 28:1807–1816CrossRefGoogle Scholar
  13. 13.
    Duke E, Kalb B, Arif-Tiwari H, et al. (2016) A systematic review and meta-analysis of diagnostic performance of MRI for evaluation of acute appendicitis. AJR 206(3):508–517CrossRefGoogle Scholar
  14. 14.
    Johnson AK, Filippi CG, Andrews T, et al. (2012) Ultrafast 3-T MRI in the evaluation of children with acute lower abdominal pain for the detection of appendicitis. AJR 198:1424–1430CrossRefGoogle Scholar
  15. 15.
    Moore MM, Gustas CN, Choudhary AK, et al. (2012) MRI for clinically suspected pediatric appendicitis: an implemented program. Pediatr Radiol 42:1056–1063CrossRefGoogle Scholar
  16. 16.
    Rosines LA, Chow DS, Lampl BS, et al. (2014) Value of gadolinium-enhanced MRI in detection of acute appendicitis in children and adolescents. AJR 203(5):543–548CrossRefGoogle Scholar
  17. 17.
    Koning JL, Naheed JH, Kruk PG (2014) Diagnostic performance of contrast-enhanced MR for acute appendicitis and alternative causes of abdominal pain in children. Pediatr Radiol 44:948–955CrossRefGoogle Scholar
  18. 18.
    Gurney PT, Hargreaves BA, Nishimura DG (2006) Design and analysis of a practical 3D cones trajectory. Magn Reson Med 55(3):575–582CrossRefGoogle Scholar
  19. 19.
    Zucker EJ, Cheng JY, Haldipur A, et al. (2018) Free-breathing pediatric chest MRI: performance of self-navigated golden-angle ordered conical ultrashort echo time acquisition. J Magn Reson Imaging 47:200–209CrossRefGoogle Scholar
  20. 20.
    Carl M, Bydder GM, Du J (2016) UTE imaging with simultaneous water and fat signal suppression using a time-efficient multispoke inversion recovery pulse sequence. Magn Reson Med 55:575–582Google Scholar
  21. 21.
    Kazantsev IG, Matej S, Lewitt RM (2005) Optimal ordering of projections using permutation matrices and angles between projection subspaces. Electron Notes Discret Math 20:205–216CrossRefGoogle Scholar
  22. 22.
    Robison RK, Anderson AG III, Pipe JG (2016) Three-dimensional ultrashort echo-time imaging using a FLORET trajectory. Magn Reson Med.  https://doi.org/10.1002/mrm.26500 Google Scholar
  23. 23.
    Winkelmann S, Schaeffter T, Koehler T, et al. (2007) An optimal radial profile order based on the golden ratio for time-resolved MRI. IEEE Trans Med Imaging 26:68–76CrossRefGoogle Scholar
  24. 24.
    Zhang T, Cheng JY, Chen Y, et al. (2016) Robust self-navigated body MRI using dense coil arrays. Magn Reson Med 76:197–205CrossRefGoogle Scholar
  25. 25.
    Chang EY, Du J, Chung CB (2015) UTE imaging in the musculoskeletal system. J Magn Reson Imaging 41(4):870–883CrossRefGoogle Scholar
  26. 26.
    Siriwanarangsun P, Statum S, Biswas R, et al. (2016) Ultrashort time to echo magnetic resonance techniques for the musculoskeletal system. Quant Imaging Med Surg 6(6):731–743CrossRefGoogle Scholar
  27. 27.
    Serai SD, Laor T, Dwek JR, et al. (2014) Feasibility of ultrashort TE (UTE) imaging of children at 1.5 T. Pediatr Radiol 44(1):103–108CrossRefGoogle Scholar
  28. 28.
    Shu SH, Cao Y, Lawrence TS, et al. (2015) Quantitative characterization of ultrashort echo (UTE) images for supporting air-bone separation in the head. Phys Med Biol 60(7):2869–2880CrossRefGoogle Scholar
  29. 29.
    Ohno Y, Koyama H, Yoshikawa T, et al. (2016) Pulmonary high-resolution ultrashort TE MR imaging: comparison with thin-section standard- and low-dose computed tomography for the assessment of pulmonary parenchyma diseases. J Magn Reson Imaging 43(2):512–532CrossRefGoogle Scholar
  30. 30.
    Doyle EK, Toy K, Valdez B, et al. (2017) Ultra-short echo time images quantify high liver iron. Magn Reson Med.  https://doi.org/10.1002/mrm.26791 Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Albert T. Roh
    • 1
  • Zhibo Xiao
    • 2
  • Joseph Y. Cheng
    • 1
  • Shreyas S. Vasanawala
    • 1
  • Andreas M. Loening
    • 1
    Email author
  1. 1.RadiologyStanford UniversityStanfordUSA
  2. 2.RadiologyFirst Affiliated HospitalChongqingChina

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