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The diagnostic performance of reduced-dose CT for suspected appendicitis in paediatric and adult patients: A systematic review and diagnostic meta-analysis

  • Gastrointestinal
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Abstract

Objective

To evaluate the diagnostic performance of reduced-dose CT for suspected appendicitis.

Methods

A systematic search of the MEDLINE and EMBASE databases was carried out through to 10 January 2017. Studies evaluating the diagnostic performance of reduced-dose CT for suspected appendicitis in paediatric and adult patients were selected. Pooled summary estimates of sensitivity and specificity were calculated using hierarchical logistic regression modelling. Meta-regression was performed.

Results

Fourteen original articles with a total of 3,262 patients were included. For all studies using reduced-dose CT, the summary sensitivity was 96 % (95 % CI 93–98) with a summary specificity of 94 % (95 % CI 92–95). For the 11 studies providing a head-to-head comparison between reduced-dose CT and standard-dose CT, reduced-dose CT demonstrated a comparable summary sensitivity of 96 % (95 % CI 91–98) and specificity of 94 % (95 % CI 93–96) without any significant differences (p=.41). In meta-regression, there were no significant factors affecting the heterogeneity. The median effective radiation dose of the reduced-dose CT was 1.8 mSv (1.46–4.16 mSv), which was a 78 % reduction in effective radiation dose compared to the standard-dose CT.

Conclusion

Reduced-dose CT shows excellent diagnostic performance for suspected appendicitis.

Key Points

• Reduced-dose CT shows excellent diagnostic performance for evaluating suspected appendicitis.

• Reduced-dose CT has a comparable diagnostic performance to standard-dose CT.

• Median effective radiation dose of reduced-dose CT was 1.8 mSv (1.46–4.16).

• Reduced-dose CT achieved a 78 % dose reduction compared to standard-dose CT.

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Abbreviations

CT:

Computed tomography

DLP:

Dose length product

QUADAS-2:

Quality Assessment of Diagnostic Accuracy Studies-2

HSROC:

Hierarchical summary receiver operating characteristic

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Funding

This study was supported by a grant (2017-0202) from Asan Medical Center Children’s Hospital, Seoul, Republic of Korea.

Author information

Author notes

  1. Hee Mang Yoon and Chong Hyun Suh contributed equally to this work.

Authors and Affiliations

  1. Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-Ro, Songpa-Gu, Seoul, 05505, Republic of Korea

    Hee Mang Yoon, Young Ah Cho, Jeong Rye Kim, Jin Seong Lee, Ah Young Jung & So Yeon Kim

  2. Department of Radiology, Namwon Medical Center, 365, Chungjeong-ro, Namwon-si, Jeollabuk-do, 590-702, Republic of Korea

    Chong Hyun Suh

  3. Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-Ro, Songpa-Gu, Seoul, 05505, Republic of Korea

    Jung Heon Kim

  4. Department of Pediatrics, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-Ro, Songpa-Gu, Seoul, 05505, Republic of Korea

    Jeong-Yong Lee

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  1. Hee Mang Yoon
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Corresponding author

Correspondence to Young Ah Cho.

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Guarantor

The scientific guarantor of this publication is Ah Young Cho.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors (Chong Hyun Suh) has significant statistical expertise (4 years of experience in a systematic review and meta-analysis).

Ethical approval

Institutional Review Board approval was not required because of the nature of our study, which was a systemic review and meta-analysis.

Informed consent

Written informed consent was not required for this study because of the nature of our study, which was a systemic review and meta-analysis.

Methodology

• Systemic review

• Meta-analysis performed at one institution

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Yoon, H.M., Suh, C.H., Cho, Y.A. et al. The diagnostic performance of reduced-dose CT for suspected appendicitis in paediatric and adult patients: A systematic review and diagnostic meta-analysis. Eur Radiol 28, 2537–2548 (2018). https://doi.org/10.1007/s00330-017-5231-z

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  • DOI: https://doi.org/10.1007/s00330-017-5231-z

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