Abdominal radiology (New York) · 2026
Accuracy of magnetic resonance imaging for acute appendicitis in pregnant women: an updated diagnostic systematic review and meta-analysis.
СтатьяМетаанализСистематический обзорНазвание и аннотация: Перевод в очереди
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Habiro Alves Lucas, Machado Guilherme Franceschini, Martin Giovanna Cristina de Castro, Lemos Maria Julia, Sarquis Maria, Dos Santos Priscila Luiza, Armstrong Bruna Benigna Sales, Barbosa Davi, Sciorilli João, Servidoni Ana Clara Pimenta, Barbisan Cinthia Callegari, Taneja Atul Kumar
Аннотация
OBJECTIVES: Diagnosing acute appendicitis during pregnancy is challenging due to physiological changes and concerns regarding fetal radiation exposure from Computed Tomography (CT). This systematic review and meta-analysis evaluates the diagnostic accuracy and safety of Magnetic Resonance Imaging (MRI) for suspected acute appendicitis, providing an updated synthesis based on a large dataset and modern MRI protocols.
METHODS: Following PRISMA guidelines and PROSPERO registration, we performed a systematic review and diagnostic meta-analysis. Studies involving pregnant women with suspected appendicitis, extractable diagnostic accuracy data (true positives, false positives, false negatives, true negatives), and surgical/histopathological confirmation were included. PubMed, EMBASE, and Cochrane Central were systematically searched until September 3, 2025. Risk of bias was assessed using QUADAS-2, and evidence certainty with GRADE. Statistical analysis used R, employing bivariate random-effects models for sensitivity/specificity, sROC curves, meta-regression, and Deeks' test for publication bias. Thirty-four studies were included.
RESULTS: Pooled sensitivity was 0.95 (95% CI: 0.91-0.98; I² = 0%) and pooled specificity 0.97 (95% CI: 0.96-0.98; I² = 55.3%), demonstrating strong diagnostic performance (AUC = 0.961; Diagnostic Odds Ratio = 273.1). A positive MRI result increased post-test probability from 30% to 93%, while a negative result reduced it to 2.2%. QUADAS-2 revealed patient selection and index-test interpretation as common bias sources, particularly in older retrospective studies. Moderate heterogeneity in specificity (I² = 55.3%) was observed, but not explained by gestational age. Deeks' test indicated potential publication bias (p = 0.0024), though pooled estimates remained robust in sensitivity analyses.
CONCLUSION: Non-contrast MRI is a highly accurate and safe diagnostic tool for suspected acute appendicitis in pregnancy, demonstrating performance comparable to CT in non-pregnant populations. We recommend MRI as the standard second-line imaging modality following inconclusive ultrasound findings to enhance diagnostic confidence, minimize fetal radiation exposure, and reduce unnecessary surgical interventions.
METHODS: Following PRISMA guidelines and PROSPERO registration, we performed a systematic review and diagnostic meta-analysis. Studies involving pregnant women with suspected appendicitis, extractable diagnostic accuracy data (true positives, false positives, false negatives, true negatives), and surgical/histopathological confirmation were included. PubMed, EMBASE, and Cochrane Central were systematically searched until September 3, 2025. Risk of bias was assessed using QUADAS-2, and evidence certainty with GRADE. Statistical analysis used R, employing bivariate random-effects models for sensitivity/specificity, sROC curves, meta-regression, and Deeks' test for publication bias. Thirty-four studies were included.
RESULTS: Pooled sensitivity was 0.95 (95% CI: 0.91-0.98; I² = 0%) and pooled specificity 0.97 (95% CI: 0.96-0.98; I² = 55.3%), demonstrating strong diagnostic performance (AUC = 0.961; Diagnostic Odds Ratio = 273.1). A positive MRI result increased post-test probability from 30% to 93%, while a negative result reduced it to 2.2%. QUADAS-2 revealed patient selection and index-test interpretation as common bias sources, particularly in older retrospective studies. Moderate heterogeneity in specificity (I² = 55.3%) was observed, but not explained by gestational age. Deeks' test indicated potential publication bias (p = 0.0024), though pooled estimates remained robust in sensitivity analyses.
CONCLUSION: Non-contrast MRI is a highly accurate and safe diagnostic tool for suspected acute appendicitis in pregnancy, demonstrating performance comparable to CT in non-pregnant populations. We recommend MRI as the standard second-line imaging modality following inconclusive ultrasound findings to enhance diagnostic confidence, minimize fetal radiation exposure, and reduce unnecessary surgical interventions.