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Characterization and quantification of fluid in the abdomen by ultrasound and magnetic resonance imaging in children with clinical suspicion of appendicitis

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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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Acknowledgements

Rahim Moineddin for his support in the statistical analysis discussions.

Funding

This study was funded by the Physicians’ Services Incorporated (PSI), Dr. Doria as Principal Investigator (PI) and Dr. Schuh as Co-PI.

Author information

Author notes

  1. Suzanne Schuh and Andrea S. Doria share senior authorship of this manuscript.

Authors and Affiliations

  1. Department of Diagnostic Imaging and Research Institute, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada

    Sara Rodriguez-Takeuchi, Karen Sousa-Plata, Carina Man, Logi Vidarson, Tammy Rayner, Arun Mohanta, Afsaneh Amirabadi, Suzanne Schuh & Andrea S. Doria

  2. Emergency Department, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada

    Sara Rodriguez-Takeuchi, Karen Sousa-Plata, Carina Man, Logi Vidarson, Tammy Rayner, Arun Mohanta, Afsaneh Amirabadi, Suzanne Schuh & Andrea S. Doria

  3. Department of Diagnostic Imaging, Fundacion Valle de Lili, Cali, Colombia

    Sara Rodriguez-Takeuchi

  4. Department of Medical Imaging, University of Toronto, Toronto, ON, M5G 1X8, Canada

    Andrea S. Doria

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Correspondence to Andrea S. Doria.

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Conflict of interest

Authors are required to disclose financial or non-financial interests that are directly or indirectly related to the work submitted for publication. Andrea S. Doria has had, during the past 3 years, the following relationships unrelated to this work. Research Support: Baxalta-Shire (Research Grant), Novo Nordisk (Research Grant), Terry Fox Foundation (Research Grant), Society of Pediatric Radiology (Research Grant), Garron Family Cancer Centre (Research Grant).

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Waiver of patient informed consent was obtained for this retrospective study.

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Rodriguez-Takeuchi, S., Sousa-Plata, K., Man, C. et al. Characterization and quantification of fluid in the abdomen by ultrasound and magnetic resonance imaging in children with clinical suspicion of appendicitis. Abdom Radiol 49, 1031–1041 (2024). https://doi.org/10.1007/s00261-023-04133-3

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