Performance of MRI for suspected appendicitis in pediatric patients and negative appendectomy rate: A systematic review and meta-analysis

Abstract

Purpose: To evaluate in pediatric patients the diagnostic performance of magnetic resonance imaging (MRI) for suspected appendicitis and its negative appendectomy rate.

Materials and methods: The study involved diagnostic accuracy studies that used MRI for pediatric patients with suspected appendicitis. Various field strengths and sequences were used in each included study. The diagnostic accuracy of MRI in pediatric patients with suspected appendicitis and negative appendectomy rate were assessed. A search of MEDLINE and EMBASE databases was performed until January 10, 2017. Two reviewers assessed the methodological quality of the articles using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. Pooled sensitivity and specificity for appendicitis diagnosis were calculated using hierarchical logistic regression modeling. Meta-regression was performed to explore factors affecting study heterogeneity. The pooled negative appendectomy rate was analyzed.

Results: Thirteen original articles with 1946 patients were included. The summary sensitivity and specificity were 97% (95% confidence interval [CI], 95-98%) and 97% (95% CI, 93-98%), respectively; the area under the hierarchical summary receiver operating characteristic (HSROC) curve was 0.98 (95% CI, 0.97-0.99). In meta-regression, use of diffusion-weighted imaging (P < 0.01) and age (P < 0.01) affected heterogeneity, but there was no difference according to intravenous contrast agent use (P = 0.95). The pooled negative appendectomy rate of MRI was 4.5% (95% CI, 1.9-7.1%).

Conclusion: MRI shows excellent diagnostic performance for appendicitis in pediatric patients regardless of the use of intravenous contrast media. Therefore, nonenhanced-only MRI protocols might be appropriate for pediatric patients with suspected appendicitis.

Level of evidence: 3 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2018;47:767-778.

Keywords: MRI; appendicitis; children; magnetic resonance imaging.