Diagnostic Performance of Magnetic Resonance Imaging for Detection of Acute Appendicitis in Pregnant Women; a Systematic Review and Meta-Analysis
Archives of Academic Emergency Medicine,
Vol. 10 No. 1 (2022),
1 January 2022
,
Page e81
https://doi.org/10.22037/aaem.v10i1.1727
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.
- Appendicitis
- magnetic resonance imaging
- meta-analysis
- pregnancy
How to Cite
References
Maimaiti A, Aierkin A, Mahmood KM, Apaer S, Maimaiti Y, Yibulayin X, et al. Laparoscopic Appendectomy in Pregnancy With Acute Appendicitis: Single Center Experience With World Review. Surg Laparosc Endosc Percutan Tech. 2017;27(6):460-4.
Franca Neto AH, Amorim MM, Nóbrega BM. Acute appendicitis in pregnancy: literature review. Rev Assoc Med Bras (1992). 2015;61(2):170-7.
Weinstein MS, Feuerwerker S, Baxter JK. Appendicitis and Cholecystitis in Pregnancy. Clin Obstet Gynecol. 2020;63(2):405-15.
Moghadam MN, Salarzaei M, Shahraki Z. Diagnostic accuracy of ultrasound in diagnosing acute appendicitis in pregnancy: a systematic review and meta-analysis. Emerg Radiol. 2022.
Kozan R, Bayhan H, Soykan Y, Anadol AZ, Sare M, Aytac AB. Acute Appendicitis in Pregnancy: How to Manage? Sisli Etfal Hastan Tip Bul. 2020;54(4):457-62.
Mantoglu B, Altintoprak F, Firat N, Gonullu E, Dikicier E, Akdeniz Y, et al. Reasons for Undesirable Pregnancy Outcomes among Women with Appendicitis: The Experience of a Tertiary Center. Emerg Med Int. 2020;2020:6039862.
Leeuwenburgh MM, Wiarda BM, Jensch S, van Es HW, Stockmann HB, Gratama JWC, et al. Accuracy and interobserver agreement between MR-non-expert radiologists and MR-experts in reading MRI for suspected appendicitis. European journal of radiology. 2014;83(1):103-10.
van Randen A, Bipat S, Zwinderman AH, Ubbink DT, Stoker J, Boermeester MA. Acute appendicitis: meta-analysis of diagnostic performance of CT and graded compression US related to prevalence of disease. Radiology. 2008;249(1):97-106.
Hiersch L, Yogev Y, Ashwal E, From A, Ben-Haroush A, Peled Y. The impact of pregnancy on the accuracy and delay in diagnosis of acute appendicitis. The Journal of Maternal-Fetal & Neonatal Medicine. 2014;27(13):1357-60.
Kwan ML, Miglioretti DL, Marlow EC, Aiello Bowles EJ, Weinmann S, Cheng SY, et al. Trends in Medical Imaging During Pregnancy in the United States and Ontario, Canada, 1996 to 2016. JAMA Netw Open. 2019;2(7):e197249.
Duke E, Kalb B, Arif-Tiwari H, Daye ZJ, Gilbertson-Dahdal D, Keim SM, et al. A systematic review and meta-analysis of diagnostic performance of MRI for evaluation of acute appendicitis. American Journal of Roentgenology. 2016;206(3):508-17.
Burns M, Hague CJ, Vos P, Tiwari P, Wiseman SM. Utility of magnetic resonance imaging for the diagnosis of appendicitis during pregnancy: a Canadian experience. Canadian Association of Radiologists Journal. 2017;68(4):392-400.
Basaran A, Basaran M. Diagnosis of acute appendicitis during pregnancy: a systematic review. Obstetrical & gynecological survey. 2009;64(7):481-8.
Kanal E, Barkovich AJ, Bell C, Borgstede JP, Bradley WG, Jr., Froelich JW, et al. ACR guidance document for safe MR practices: 2007. AJR Am J Roentgenol. 2007;188(6):1447-74.
Al-Katib S, Sokhandon F, Farah M. MRI for appendicitis in pregnancy: is seeing believing? clinical outcomes in cases of appendix nonvisualization. Abdominal Radiology. 2016;41(12):2455-9.
Caruso M, Dell'Aversano Orabona G, Di Serafino M, Iacobellis F, Verde F, Grimaldi D, et al. Role of Ultrasound in the Assessment and Differential Diagnosis of Pelvic Pain in Pregnancy. Diagnostics (Basel). 2022;12(3).
Ahmed B, Williams J, Gourash W, Zhang J, Li R, Balasubramani GK, et al. MRI as First Line Imaging for Suspected Acute Appendicitis during Pregnancy: Diagnostic Accuracy and level of Inter-Radiologist Agreement. Current Problems in Diagnostic Radiology. 2021.
Badr DA, Selsabil M-H, Thill V, Dobos S, Ostrovska A, Jani JC, et al. Acute appendicitis and pregnancy: diagnostic performance of magnetic resonance imaging. The Journal of Maternal-Fetal & Neonatal Medicine. 2021:1-4.
Lukenaite B, Luksaite-Lukste R, Mikalauskas S, Samuilis A, Strupas K, Poškus T. Magnetic resonance imaging reduces the rate of unnecessary operations in pregnant patients with suspected acute appendicitis: a retrospective study. Annals of surgical treatment and research. 2021;100(1):40.
Aguilera F, Gilchrist BF, Farkas DT. Accuracy of MRI in diagnosing appendicitis during pregnancy. The American Surgeon. 2018;84(8):1326-8.
Kereshi B, Lee KS, Siewert B, Mortele KJ. Clinical utility of magnetic resonance imaging in the evaluation of pregnant females with suspected acute appendicitis. Abdominal Radiology. 2018;43(6):1446-55.
Wi SA, Kim DJ, Cho E-S, Kim KA. Diagnostic performance of MRI for pregnant patients with clinically suspected appendicitis. Abdominal Radiology. 2018;43(12):3456-61.
Tsai R, Raptis C, Fowler KJ, Owen JW, Mellnick VM. MRI of suspected appendicitis during pregnancy: interradiologist agreement, indeterminate interpretation and the meaning of non-visualization of the appendix. The British Journal of Radiology. 2017;90(1079):20170383.
Patel D, Fingard J, Winters S, Low G. Clinical use of MRI for the evaluation of acute appendicitis during pregnancy. Abdominal Radiology. 2017;42(7):1857-63.
Abadi S, Javitt M. Feasibility of emergency MRI for suspected appendicitis in pregnant women. Isr Med Assoc J. 2016;18:625-6.
Burke LM, Bashir MR, Miller FH, Siegelman ES, Brown M, Alobaidy M, et al. Magnetic resonance imaging of acute appendicitis in pregnancy: a 5-year multiinstitutional study. American journal of obstetrics and gynecology. 2015;213(5):693. e1-. e6.
Konrad J, Grand D, Lourenco A. MRI: first-line imaging modality for pregnant patients with suspected appendicitis. Abdominal imaging. 2015;40(8):3359-64.
Ramalingam V, LeBedis C, Kelly JR, Uyeda J, Soto JA, Anderson SW. Evaluation of a sequential multi-modality imaging algorithm for the diagnosis of acute appendicitis in the pregnant female. Emergency radiology. 2015;22(2):125-32.
Theilen LH, Mellnick VM, Longman RE, Tuuli MG, Odibo AO, Macones GA, et al. Utility of magnetic resonance imaging for suspected appendicitis in pregnant women. American journal of obstetrics and gynecology. 2015;212(3):345. e1-. e6.
Fonseca AL, Schuster KM, Kaplan LJ, Maung AA, Lui FY, Davis KA. The use of magnetic resonance imaging in the diagnosis of suspected appendicitis in pregnancy: shortened length of stay without increase in hospital charges. JAMA surgery. 2014;149(7):687-93.
Rapp EJ, Naim F, Kadivar K, Davarpanah A, Cornfeld D. Integrating MR imaging into the clinical workup of pregnant patients suspected of having appendicitis is associated with a lower negative laparotomy rate: single-institution study. Radiology. 2013;267(1):137-44.
Jang KM, Kim SH, Choi D, Lee SJ, Rhim H, Park MJ. The value of 3D T1-weighted gradient-echo MR imaging for evaluation of the appendix during pregnancy: preliminary results. Acta Radiologica. 2011;52(8):825-8.
Masselli G, Brunelli R, Casciani E, Polettini E, Bertini L, Laghi F, et al. Acute abdominal and pelvic pain in pregnancy: MR imaging as a valuable adjunct to ultrasound? Abdominal imaging. 2011;36(5):596-603.
Oto A, Ernst RD, Ghulmiyyah LM, Nishino TK, Hughes D, Chaljub G, et al. MR imaging in the triage of pregnant patients with acute abdominal and pelvic pain. Abdominal imaging. 2009;34(2):243-50.
Pedrosa I, Lafornara M, Pandharipande PV, Goldsmith JD, Rofsky NM. Pregnant patients suspected of having acute appendicitis: effect of MR imaging on negative laparotomy rate and appendiceal perforation rate. Radiology. 2009;250(3):749-57.
Vu L, Ambrose D, Vos P, Tiwari P, Rosengarten M, Wiseman S. Evaluation of MRI for the diagnosis of appendicitis during pregnancy when ultrasound is inconclusive. Journal of Surgical Research. 2009;156(1):145-9.
Israel GM, Malguria N, McCarthy S, Copel J, Weinreb J. MRI vs. ultrasound for suspected appendicitis during pregnancy. Journal of Magnetic Resonance Imaging: An Official Journal of the International Society for Magnetic Resonance in Medicine. 2008;28(2):428-33.
Pedrosa I, Levine D, Eyvazzadeh AD, Siewert B, Ngo L, Rofsky NM. MR imaging evaluation of acute appendicitis in pregnancy. Radiology. 2006;238(3):891-9.
Birchard KR, Brown MA, Hyslop WB, Firat Z, Semelka RC. MRI of acute abdominal and pelvic pain in pregnant patients. AJR Am J Roentgenol. 2005;184(2):452-8.
Cobben L, Groot I, Haans L, Blickman J, Puylaert J. MRI for clinically suspected appendicitis during pregnancy. Magnetic resonance imaging in acute appendicitis. 2009:105.
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