Deep learning reconstruction improves appendix visualization on pediatric MRI: a single-center experience

Background Thin-slice MRI may improve appendix visualization in children with suspected appendicitis, but reducing slice thickness decreases signal-to-noise ratio (SNR) and can degrade image quality. Deep learning reconstruction (DLR) enables denoising of thin-slice images and may mitigate these limitations. Objective To evaluate whether 2-mm T2-weighted MRI with DLR improves appendix visualization and diagnostic performance compared with conventional 4-mm MRI in pediatric appendicitis. Materials and methods In this prospective single-center study (January 2022-June 2025), 82 children (mean age 9.6 years) undergoing MRI for suspected appendicitis were included. MRI protocols contained both standard 4-mm and thin-slice 2-mm single-shot T2-weighted images; DLR was applied to 2-mm images (2-mm + DLR). Three blinded radiologists independently assessed paired series for appendix visualization, confidence, appendicitis diagnosis, ancillary findings, and overall image quality. Objective SNR was measured in psoas muscle, bladder, and fat. Diagnostic performance was calculated against surgical or clinical reference standards using paired statistical tests. Results DLR significantly increased appendix visualization compared with standard MRI (88.2% vs 83.3%, p = 0.006). Overall diagnostic quality scores were higher with 2-mm + DLR (median 5 vs 4, p = 0.0004), while confidence in appendix visualization and appendicitis diagnosis were similar (both medians 4, p > 0.1). SNR of 2-mm + DLR was significantly higher than non-DLR 2-mm images (all p < 0.01) and comparable to 4-mm images. Pooled diagnostic performance favored 2-mm + DLR (sensitivity 88% vs 80%, accuracy 91% vs 86%), although paired comparisons did not reach statistical significance. Conclusion DLR-enhanced 2-mm MRI improves appendix visualization and overall diagnostic image quality in pediatric appendicitis without reducing reader confidence or specificity. Thin-slice DLR MRI supports improved depiction of the appendix and alternative abdominal pathology in children.