0:01

So MRI can have limitations,

0:03

which are important to keep in mind.

0:04

They are very sensitive to motion.

0:06

You may need occasional anesthesia or

0:10

some sort of sedation if the child is

0:12

young enough and can't stay still for it.

0:14

MRI is limited in evaluating for free air.

0:17

So just things to keep in mind.

0:19

But it is often still quite diagnostic

0:23

and maybe better than a CT scan.

0:25

So in this case, another child,

0:27

you can follow that colon down.

0:28

In this case, it's a bit harder to identify

0:32

the appendix versus the terminal ileum.

0:33

You do have this.

0:35

It's a thick-walled structure that has

0:37

what looks like bowel signature that

0:38

does appear to attach here to the cecum.

0:42

I find it hard in this particular case to

0:44

tell exactly where the terminal ileum is to

0:46

prove that this is the appendix, but we do

0:47

have these T2 dark structures within this

0:51

loop of bowel here that could be air, you

0:54

know, or they certainly could be appendicoliths.

0:56

The structure, however, when you

0:57

follow it, it does look blind-ending.

0:59

It just stops here in the right lower quadrant.

1:01

You see some T2 bright free fluid here,

1:04

and then what's more importantly here, you

1:06

didn't just diagnose acute appendicitis,

1:08

but you're looking for the complications.

1:09

So here we have an example of an abscess

1:12

from an acute appendicitis on MRI.

1:14

So this is the bladder anteriorly, it's being

1:16

squished by this volume of fluid right here.

1:20

This is not just free fluid, it's

1:22

pushing on the structures nearby.

1:23

This is an abscess.

1:25

It is thick-walled.

1:26

It has an air-fluid level right here.

1:28

Here's a little bit of air.

1:29

That's rising on the pus,

1:31

basically sitting back here.

1:33

It's a little bit heterogeneous because

1:35

remember it is purulent material.

1:38

And then you have a little bit of,

1:40

sorry, rectum back here behind it.

1:42

Thick-walled back here as well.

1:44

And that's reactive in this case because

1:45

there's a large abscess sitting upon it.

1:47

So in these cases, you do not need contrast.

1:51

This is a relatively quick exam.

1:52

It's just several coronal and

1:54

axial T2-weighted imaging.

1:56

No contrast is necessary for these.

1:58

And you can diagnose acute appendicitis and

2:00

an abscess, both in the same examination,

2:04

relatively quick for these kids.

2:05

So they don't have to be under

2:06

anesthesia very long if they need it.

2:08

And if they're older and don't need

2:09

it, they can tolerate the exam quite

2:11

well, given that it's relatively short.