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Background <p>Since the last publication of meta-analyses on pediatric acute appendicitis imaging in 2016 and 2018, ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI) technology and protocols have improved, and there are new reports on their accuracy.</p> Objective <p>We determined sensitivity, specificity, and diagnostic odds ratios (DOR) of the US, CT, and MRI for pediatric acute appendicitis, in studies published from 2015 to 2024.</p> Materials and methods <p>PubMed, MEDLINE, BVS, OVID, Web of Science, and Trip Database (Jan 2015-May 2024) were searched for studies in patients less than 21&#xa0;years old with suspected acute appendicitis. Histopathology and clinical follow-up were the reference standard. Those with insufficient data for a 2 × 2 contingency table were excluded. QUADAS-2 directed risk of bias assessment. Data were extracted for meta-analysis.</p> Results <p>Our review of 37 articles included 22 conventional US studies (20,897 patients), 4 point-of-care US (POCUS) studies (280), 4 CT studies (1,389), and 13 MRI studies (2,630). Pooled sensitivity, specificity, and DOR were: conventional US: 0.93 (95% CI [0.87, 0.96]), 0.89 (95% CI [0.80, 0.95]), 115.23 (95% CI [-32.88, 263.34]); POCUS: 0.80 (95% CI [0.61, 0.91]), 0.93 (95% CI [0.83, 0.98]), 53.97 (95% CI [-39, 146.94]); CT: 0.96 (95% CI [0.93, 0.97]), 0.98 (95% CI [0.96, 0.98]), 864.43 (95% CI [264.02, 1,464.84]); MRI: 0.96 (95% CI [0.94, 0.97]), 0.98 (95% CI [0.96, 0.99]), 1,030.42 (95% CI [222.05, 1,838.8]). No statistically significant differences were found (<i>P</i> = 0.07). For quantitative synthesis, US and POCUS studies had the highest heterogeneity.</p> Conclusion <p>All four modalities have high diagnostic accuracy.</p> Registration <p>PROSPERO: CRD42024538086. May 5, 2024. Retrospectively registered.</p> <p>PROSPERO registration name: Ultrasound, computed tomography or magnetic resonance imaging for diagnosing acute appendicitis in children and adolescents.</p> Graphical abstract <p></p>

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Contemporary ultrasound, computed tomography, or magnetic resonance imaging for acute appendicitis diagnosis in children and adolescents: systematic review and meta-analysis

  • 期刊论文

  • 发表日期：

    2025年5月9日

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  • Diana Isabel Castro-Luna,
  • Juan D. Porras-Hernandez,
  • Jose Andres Flores-Garcia,
  • Pilar Dies-Suarez,
  • Maria Fernanda Servin-Martinez,
  • Mauricio Pierdant-Perez

摘要

Background

Since the last publication of meta-analyses on pediatric acute appendicitis imaging in 2016 and 2018, ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI) technology and protocols have improved, and there are new reports on their accuracy.

Objective

We determined sensitivity, specificity, and diagnostic odds ratios (DOR) of the US, CT, and MRI for pediatric acute appendicitis, in studies published from 2015 to 2024.

Materials and methods

PubMed, MEDLINE, BVS, OVID, Web of Science, and Trip Database (Jan 2015-May 2024) were searched for studies in patients less than 21 years old with suspected acute appendicitis. Histopathology and clinical follow-up were the reference standard. Those with insufficient data for a 2 × 2 contingency table were excluded. QUADAS-2 directed risk of bias assessment. Data were extracted for meta-analysis.

Results

Our review of 37 articles included 22 conventional US studies (20,897 patients), 4 point-of-care US (POCUS) studies (280), 4 CT studies (1,389), and 13 MRI studies (2,630). Pooled sensitivity, specificity, and DOR were: conventional US: 0.93 (95% CI [0.87, 0.96]), 0.89 (95% CI [0.80, 0.95]), 115.23 (95% CI [-32.88, 263.34]); POCUS: 0.80 (95% CI [0.61, 0.91]), 0.93 (95% CI [0.83, 0.98]), 53.97 (95% CI [-39, 146.94]); CT: 0.96 (95% CI [0.93, 0.97]), 0.98 (95% CI [0.96, 0.98]), 864.43 (95% CI [264.02, 1,464.84]); MRI: 0.96 (95% CI [0.94, 0.97]), 0.98 (95% CI [0.96, 0.99]), 1,030.42 (95% CI [222.05, 1,838.8]). No statistically significant differences were found (P = 0.07). For quantitative synthesis, US and POCUS studies had the highest heterogeneity.

Conclusion

All four modalities have high diagnostic accuracy.

Registration

PROSPERO: CRD42024538086. May 5, 2024. Retrospectively registered.

PROSPERO registration name: Ultrasound, computed tomography or magnetic resonance imaging for diagnosing acute appendicitis in children and adolescents.

Graphical abstract