Abstract
BackgroundThe aim of this systematic review and meta-analysis was to evaluate the clinical use of MRI for the evaluation of acute appendicitis during pregnancy.MethodsThe searches were conducted by two independent researchers (MK, MS) to find the relevant studies published from 1/1/2009 until end of 30/12/2018. We searched for published literature in the English language in MEDLINE via PubMed, EMBASETM via Ovid, The Cochrane Library, and Trip database. For literature published in other languages, we searched national databases (Magiran and SID), KoreaMed, and LILACS. The keywords used in the search strategy are Pregnancy [MeSH], Pregnant [MeSH] OR—Magnetic resonance imaging [MeSH] OR—Appendicitis [MeSH] OR—Ultrasound, [MeSH] OR, imaging, MRI [MeSH] OR"،" and Right lower quadrant pain [MeSH]. The risk of bias of every article was evaluated by using QUADAS-2. On the basis of the results from the 2 × 2 tables, pooled measures for sensitivity, specificity, diagnostic odds ratio (DOR), and area under the curves (AUC) along with their 95% confidence intervals (CIs) were calculated using the DerSimonian Lair methodology.ResultsAs many as 1164 studies were selected. After analyzing the correspondence of the studies with the required criteria, 19 studies were selected for the final review. For appendicitis in pregnancy, the MRI sensitivity was 91.8% at the 95% confidence interval of (95% CI 87.7–94.9%). At the confidence interval of 95%, the specificity was 97.9% (95% CI 0.97.2–100%). The risk of bias in the studies conducted was measured using the QUADAS-2 tool.ConclusionMRI has high sensitivity and specificity (91.8%, 97.9% respectively) for the diagnosis of acute appendicitis in pregnant patients with clinically suspected appendicitis. It is an excellent imaging technique in many instances, which does not expose a fetus, or the mother, to ionizing radiation, making it an excellent option for pregnant patients with suspected acute appendicitis.
Highlights
The aim of this systematic review and meta-analysis was to evaluate the clinical use of Magnetic resonance imaging (MRI) for the evaluation of acute appendicitis during pregnancy
Due to the high number of included studies which were conducted in the USA [64,65,66,67,68,69, 73, 74, 76, 77, 79,80,81], we decided to perform a subgroup meta-analysis based on the country which was indicative of a pooled sensitivity of 91.5% and a pooled specificity of 98.1% and a diagnostic odds ratio (DOR) of 559.41 for MRI in diagnosis of appendicitis in pregnant women
Mahesh K et al [85] in a 5-year study on 39 pregnant women reported that the sensitivity of Computed tomography (CT) in the diagnosis of appendicitis in pregnant women was 100%; they reported a sensitivity of 46.1% for ultrasound, but on the other hand, Kevin A et al [86] in their metaanalysis presented a sensitivity of 89.9% and a specificity of 93.6% for CT scan in diagnosing the acute appendicitis in adults including pregnant women which is quite close and even in some countries like South Korea, The
Summary
The aim of this systematic review and meta-analysis was to evaluate the clinical use of MRI for the evaluation of acute appendicitis during pregnancy. The possibility of acute appendicitis must be ruled out, since it is the most common cause of surgical intervention in pregnancy requires immediate management [1,2,3,4,5,6,7]. The incidence rate of acute appendicitis in pregnancy has been reported to be 1:1250 and 1:1500 [8,9,10,11,12,13,14,15]. The negative laparotomy rate of suspected appendicitis is 25–50% in obstetric cases and 15–35% in general surgical cases [30,31,32,33,34,35,36]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
