Abstract
Background
There is no established consensus about the relative accuracies of US, CT and MRI in childhood appendicitis.
Objective
To compare, through meta-analysis, the accuracies of US, CT and MRI for clinically suspected acute appendicitis in children.
Materials and methods
PubMed, Embase, Web of Science and the Cochrane Library were searched. After study selection, data extraction and quality assessment, the sensitivity, specificity and the area under the curve of summary receiver operating characteristic were calculated and compared.
Results
Twenty-seven articles including 29 studies met the inclusion criteria, including 19 studies (9,170 patients) of US, 6 studies (928 patients) of CT and 4 studies (990 patients) of MRI. The analysis showed that the area under the receiver operator characteristics curve of MRI (0.995) was a little higher than that of US (0.987) and CT (0.982; P > 0.05).
Conclusion
US, CT and MRI have high diagnostic accuracies of clinically suspected acute appendicitis in children overall with no significant difference.
Similar content being viewed by others
References
Henderson J, Goldacre MJ, Fairweather JM et al (1992) Conditions accounting for substantial time spent in hospital in children aged 1-14 years. Arch Dis Child 67:83–86
Addiss DG, Shaffer N, Fowler BS et al (1990) The epidemiology of appendicitis and appendectomy in the United States. Am J Epidemiol 132:910–925
Körner H, Söndenaa K, Söreide JA et al (2000) The history is important in patients with suspected acute appendicitis. Dig Surg 17:364–368
Grover CA, Sternbach G (2012) Charles McBurney: McBurney's point. J Emerg Med 42:578–581
Puylaert JB (1986) Acute appendicitis: US evaluation using graded compression. Radiology 158:355–360
Strouse PJ (2010) Pediatric appendicitis: an argument for US. Radiology 255:8–13
Malone AJ Jr, Wolf CR, Malmed AS et al (1993) Diagnosis of acute appendicitis: value of unenhanced CT. AJR Am J Roentgenol 160:763–766
Pinto Leite N, Pereira JM, Cunha R et al (2005) CT evaluation of appendicitis and its complications: imaging techniques and key diagnostic findings. AJR Am J Roentgenol 185:406–417
Brenner D, Elliston C, Hall E et al (2001) Estimated risks of radiation-induced fatal cancer from pediatric CT. AJR Am J Roentgenol 176:289–296
Orth RC, Guillerman RP, Zhang W et al (2015) Prospective comparison of MR imaging and US for the diagnosis of pediatric appendicitis. Radiology 272:233–240
Thieme ME, Leeuwenburgh MM, Valdehueza ZD et al (2014) Diagnostic accuracy and patient acceptance of MRI in children with suspected appendicitis. Eur Radiol 24:630–637
Michael R (2008) Potential of MR-imaging in the paediatric abdomen. Eur J Radiol 68:235–244
Moore MM, Gustas CN, Choudhary AK et al (2012) MRI for clinically suspected pediatric appendicitis: an implemented program. Pediatr Radiol 42:1056–1063
Moher D, Liberati A, Tetzlaff J et al (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 21:b2535
Wiersma F, Toorenvliet BR, Bloem JL et al (2009) US examination of the appendix in children with suspected appendicitis: the additional value of secondary signs. Eur Radiol 19:455–461
Dillman JR, Gadepalli S, Sroufe NS et al (2016) Equivocal pediatric appendicitis: unenhanced MR imaging protocol for nonsedated children-a clinical effectiveness study. Radiology 279:216–225
Rao PM, Rhea JT, Novelline RA et al (1997) Helical CT technique for the diagnosis of appendicitis: prospective evaluation of a focused appendix CT examination. Radiology 202:139–144
Whiting PF, Rutjes AW, Westwood ME et al (2011) QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med 155:529–536
Higgins JPT, Green S and editors (2011) Cochrane handbook for systematic reviews of interventions version 5.1.0 [updated March 2011]. The Cochrane collaboration. Available from www.cochrane-handbook.org
Deeks JJ, Macaskill P, Irwig L (2005) The performance of tests of publication bias and other sample size effects in systematic reviews of diagnostic test accuracy was assessed. J Clin Epidemiol 58:882–893
Kaiser S, Frenckner B, Jorulf HK (2002) Suspected appendicitis in children: US and CT--a prospective randomized study. Radiology 233:633–638
Baldisserotto M, Marchiori E (2000) Accuracy of noncompressive sonography of children with appendicitis according to the potential positions of the appendix. AJR Am J Roentgenol 175:1387–1392
Baldisserotto M, Peletti AB (2007) Is colour Doppler sonography a good method to differentiate normal and abnormal appendices in children? Clin Radiol 62:365–369
Binkovitz LA, Unsdorfer KM, Thapa P et al (2015) Pediatric appendiceal ultrasound: accuracy, determinacy and clinical outcomes. Pediatr Radiol 45:1934–1944
Burford JM, Dassinger MS, Smith SD (2011) Surgeon-performed ultrasound as a diagnostic tool in appendicitis. J Pediatr Surg 46:1115–1120
Chang YJ, Kong MS, Hsia SH et al (2007) Usefulness of ultrasonography in acute appendicitis in early childhood. J Pediatr Gastroenterol Nutr 44:592–595
Hahn HB, Hoepner FU, Kalle T et al (1998) Sonography of acute appendicitis in children: 7 years experience. Pediatr Radiol 28:147–151
Limchareon S, Wongsuttilert A, Boonyarit A (2014) Efficacy of ultrasonography in the evaluation of suspected appendicitis in a pediatric population. J Med Ultrasound 22:213–217
Lowe LH, Penney MW, Stein SM et al (2001) Unenhanced limited CT of the abdomen in the diagnosis of appendicitis in children: comparison with sonography. AJR Am J Roentgenol 176:31–35
Nosaka S, Miyasaka M, Miyazaki O et al (1997) Ultrasound in pediatric patients with suspected acute appendicitis: value in establishing alternative diagnoses. Emerg Radiol 4:207–211
Peña BM, Taylor GA (2000) Radiologists' confidence in interpretation of sonography and CT in suspected pediatric appendicitis. AJR Am J Roentgenol 175:71–74
Scammell S, Lansdale N, Sprigg A et al (2011) Ultrasonography aids decision-making in children with abdominal pain. Ann R Coll Surg Engl 93:405–409
Schulte B, Beyer D, Kaiser C et al (1998) Ultrasonography in suspected acute appendicitis in childhood-report of 1285 cases. Eur J Ultrasound 8:177–182
Teo EL, Tan KP, Lam SL et al (2000) Ultrasonography and computed tomography in a clinical algorithm for the evaluation of suspected acute appendicitis in children. Singapore Med J 41:387–392
Tiu CM, Chou YH, Chen JD et al (2004) Ultrasound diagnosis of acute appendicitis: impact on cost and outcome in pediatric patients. J Med Ultrasound 12:69–74
Toprak H, Kilincaslan H, Ahmad IC et al (2014) Integration of ultrasound findings with Alvarado score in children with suspected appendicitis. Pediatr Int 56:95–99
van Atta AJ, Baskin HJ, Maves CK et al (2015) Implementing an ultrasound-based protocol for diagnosing appendicitis while maintaining diagnostic accuracy. Pediatr Radiol 45:678–685
Akhtar W, Ali S, Arshad M et al (2011) Focused abdominal CT scan for acute appendicitis in children: can it help in need? J Pak Med Assoc 61:474–476
Didier RA, Vajtai PL, Hopkins KL (2015) Iterative reconstruction technique with reduced volume CT dose index: diagnostic accuracy in pediatric acute appendicitis. Pediatr Radiol 45:181–187
Fefferman NR, Roche KJ, Pinkney LP et al (2001) Suspected appendicitis in children: focused CT technique for evaluation. Radiology 220:691–695
Hoecker CC, Billman GF (2005) The utility of unenhanced computed tomography in appendicitis in children. J Emerg Med 28:415–421
Sivit CJ, Applegate KE, Berlin SC et al (2000) Evaluation of suspected appendicitis in children and young adults: helical CT. Radiology 216:430–433
Johnson AK, Filippi CG, Andrews T et al (2012) Ultrafast 3-T MRI in the evaluation of children with acute lower abdominal pain for the detection of appendicitis. AJR Am J Roentgenol 198:1424–1430
Kulaylat AN, Moore MM, Engbrecht BW et al (2015) An implemented MRI program to eliminate radiation from the evaluation of pediatric appendicitis. J Pediatr Surg 50:1359–1363
Nitta N, Takahashi M, Furukawa A et al (2005) MR imaging of the normal appendix and acute appendicitis. J Magn Reson Imaging 21:156–165
Aspelund G, Fingeret A, Gross E et al (2014) Ultrasonography/MRI versus CT for diagnosing appendicitis. Pediatrics 133:586–593
Herliczek TW, Swenson DW, Mayo-Smith WW (2013) Utility of MRI after inconclusive ultrasound in pediatric patients with suspected appendicitis: retrospective review of 60 consecutive patients. AJR Am J Roentgenol 200:969–973
Doria AS, Moineddin R, Kellenberger CJ et al (2006) US or CT for diagnosis of appendicitis in children and adults? A meta-analysis. Radiology 241:83–94
Callahan MJ, Rodriguez DP, Taylor GA (2002) CT of appendicitis in children. Radiology 224:325–332
Hernandez JA, Swischuk LE, Angel CA et al (2005) Imaging of acute appendicitis: US as the primary imaging modality. Pediatr Radiol 35:392–395
Rosendahl K, Aukland SM, Fosse K (2004) Imaging strategies in children with suspected appendicitis. Eur Radiol 14:L138–L145
Irish MS, Pearl RH, Caty MG et al (1998) The approach to common abdominal diagnosis in infants and children. Pediatr Clin N Am 45:729–772
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflicts of interest
None
Rights and permissions
About this article
Cite this article
Zhang, H., Liao, M., Chen, J. et al. Ultrasound, computed tomography or magnetic resonance imaging - which is preferred for acute appendicitis in children? A Meta-analysis. Pediatr Radiol 47, 186–196 (2017). https://doi.org/10.1007/s00247-016-3727-3
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00247-016-3727-3