Performance of overnight on-call radiology residents in interpreting unenhanced abdominopelvic magnetic resonance imaging studies performed for pediatric right lower quadrant abdominal pain

David M Sawyer,Dorothy L Gilbertson-Dahdal,Faryal Shareef,Sara M Desoky,Raza Mushtaq,Srinivasan Vedantham,Unni K Udayasankar,Hina Arif-Tiwari

doi:10.1007/s00247-021-05009-8

David M Sawyer, Dorothy L Gilbertson-Dahdal + Show 6 more

Open Access

https://doi.org/10.1007/s00247-021-05009-8

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Abstract

BackgroundAbdominopelvic magnetic resonance imaging (MRI) is increasingly being used to evaluate children with abdominal pain suspected of having acute appendicitis. At our institution, these examinations are preliminarily interpreted by radiology residents, especially when performed after hours.ObjectiveTo determine the accuracy of preliminary reports rendered by radiology residents in this setting.Materials and methodsThree hundred seventy-seven pediatric abdominopelvic MRI examinations were included. The preliminary (resident) and final (attending) radiology reports were coded as diagnosing acute appendicitis or no acute appendicitis. The concordance between resident and attending radiologist interpretations was calculated. Additionally, both resident and attending reports were compared to available surgical pathology or clinical follow-up data.ResultsOverall concordance rate for the diagnosis of acute appendicitis was 97.1%. Concordance for verified cases of acute appendicitis was 93.4%. Concordance rates did not differ by residents’ postgraduate year levels. When compared against surgical pathology or clinical follow-up data, residents demonstrated 91.2% sensitivity and 97.6% specificity. There was no statistically significant difference in the sensitivity or specificity of resident or attending radiologist interpretations.ConclusionRadiology residents demonstrate high concordance with attending pediatric radiologists in their interpretations of pediatric abdominopelvic MRI for acute appendicitis. The diagnostic performances of residents and attendings were comparable.

Highlights

Acute appendicitis represents a prevalent and important cause of abdominal pain in pediatric patients [1]
The purpose of this study is to evaluate the diagnostic performance of radiology residents in preliminarily interpreting first-line magnetic resonance imaging (MRI) studies performed in children with clinical concern for acute appendicitis
A list of consecutive patients 21 years old or younger who presented to our institution with acute abdominal pain between January 2013 and June 2016 and underwent an unenhanced MRI examination of the abdomen and pelvis was generated from the hospital electronic medical records

Summary

Introduction

Acute appendicitis represents a prevalent and important cause of abdominal pain in pediatric patients [1]. The American College of Radiology (ACR) has recently published updated appropriateness criteria on this topic [3]. These guidelines recommend initial evaluation with ultrasound (US) for patients with an intermediate risk of acute appendicitis based on clinical assessment, followed by further evaluation with computed tomography (CT) or magnetic resonance imaging (MRI) in cases with equivocal US findings. Abdominopelvic magnetic resonance imaging (MRI) is increasingly being used to evaluate children with abdominal pain suspected of having acute appendicitis. At our institution, these examinations are preliminarily interpreted by radiology residents, especially when performed after hours

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Conclusion