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Review
. 2022 Oct 6;10(1):e81.
doi: 10.22037/aaem.v10i1.1727. eCollection 2022.

Diagnostic Performance of Magnetic Resonance Imaging for Detection of Acute Appendicitis in Pregnant Women; a Systematic Review and Meta-Analysis

Mohsen Motavaselian  1 , Fateme Bayati  2 , Reza Amani-Beni  3 , Amirreza Khalaji  4 , Sara Haghverdi  5 , Zeynab Abdollahi  6 , Arash Sarrafzadeh  7 , Amir-Masood Rafie Manzelat  3 , Amir Rigi  8 , Razman Arabzadeh Bahri  9 , Zahra Nakhaee  10 , Mahta Fadaei  11 , Hajar Ghasemi Falaverjani  12 , Sara Malekpour-Dehkordi  6 , Maryam Hoseinpour  6 , Matin Bidares  13 , Sarvenaz Zandkarimi  14 , Rasha Ahmadi  15 , Dorsa Beheshtiparvar  3 , Seyed-Amirabbas Ahadiat  16 , Mohsen Farshi  3 , Mehrdad Farrokhi  17
Affiliations
Review

Diagnostic Performance of Magnetic Resonance Imaging for Detection of Acute Appendicitis in Pregnant Women; a Systematic Review and Meta-Analysis

Mohsen Motavaselian et al. Arch Acad Emerg Med. .

Abstract

Introduction: The diagnosis of acute appendicitis (AA) in pregnant women is commonly challenging owing to the normal results of laboratory tests, organ displacement, and normal physiological inflammatory alterations. This meta-analysis aimed to investigate the accuracy of magnetic resonance imaging (MRI) in diagnosis of AA in pregnant women.

Methods: Two investigators independently performed a comprehensive systematic literature search of electronic databases including MEDLINE, Cochrane Central, EMBASE, Web of Science, Scopus, and Google Scholar to identify studies that reported accuracy of MRI for diagnosis of AA in pregnant women from inception to April 1, 2022.

Results: Our systematic search identified a total of 525 published papers. Finally, a total of 26 papers were included in the meta-analysis. The pooled sensitivity and specificity of MRI in diagnosis of AA in pregnant women were 0.92 (95% CI: 0.88-0.95) and 0.98 (95% CI 0.97-0.98), respectively. The pooled positive likelihood ratio and negative likelihood ratio were 29.52 (95% CI: 21.90-39.81) and 0.10 (95% CI: 0.04-0.25), respectively. The area under hierarchical summary receiver operating characteristic (HSROC) curve indicated that the accuracy of MRI for diagnosis of AA in pregnant women is 99%.

Conclusion: This meta-analysis showed that MRI has high sensitivity, specificity, and accuracy for diagnosis of AA in pregnant women and can be used as a first-line imaging modality for suspected cases of AA during pregnancy. Furthermore, it should be noted that when the result of ultrasonography is inconclusive, the use of MRI can reduce unnecessary appendectomy in pregnant patients.

Keywords: Appendicitis; magnetic resonance imaging; meta-analysis; pregnancy.

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Conflict of interest statement

None.

Figures

Figure 1
Figure 1
PRISMA flowchart of the literature search and selection of studies that reported accuracy of magnetic resonance imaging (MRI) for diagnosis of acute appendicitis in pregnant women
Figure 2
Figure 2
Forest plot of the pooled sensitivity, specificity, positive likelihood ratio (LR), negative LR, and diagnostic odds ratio (OR) of magnetic resonance imaging (MRI) for diagnosis of acute appendicitis in pregnant women. CI: confidence interval
Figure 3
Figure 3
Hierarchical summary receiver-operating characteristic (HSROC) curve indicating accuracy of magnetic resonance imaging (MRI) for diagnosis of acute appendicitis in pregnant women
Figure 4
Figure 4
Funnel plot of publication bias for the included studies
See this image and copyright information in PMC

References

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