Diagnostic Performance of Doppler Ultrasound for Acute Appendicitis: A Systematic Review and Diagnostic Test Accuracy Meta-Analysis
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Background: This study analyzed the diagnostic performance of Doppler ultrasound (DUS) in acute appendicitis (AA) and its ability to discriminate complicated acute appendicitis (CAA) from non-complicated acute appendicitis (NCAA). Methods: This systematic review was prospectively registered in PROSPERO (CRD42025641841). A systematic search was conducted in PubMed, Web of Science, Scopus, and Ovid. Two independent reviewers selected studies and extracted data. Methodological quality was assessed with QUADAS-2. Random-effects (RE) meta-analyses (REML method) and diagnostic test accuracy (DTA) meta-analyses were performed. Publication bias was assessed using Egger’s and Begg´s tests and Deeks' asymmetry test. Results: Twenty-one studies containing 2,774 participants with 1,112 AA patients and 1,145 controls (CG) were included. Overall DUS modalities DTA meta-analysis (26 observations) yielded a pooled sensitivity and specificity [95% CI] of 86% [79-91] and 94% [90-96]. The pooled area under the ROC curve (AUROC) was 0.96. The DTA meta-analysis for spectral Doppler (AA vs. CG) included 10 observations and yielded a pooled sensitivity and specificity [95% CI] of 88% [80–93] and 87% [77–93], respectively. The pooled AUC was 0.94. The DTA meta-analysis for color Doppler (AA vs. CG) included 13 observations and yielded a pooled sensitivity and specificity [95% CI] of 82 [70-90] % and 97 [92-99] %. The pooled AUC was 0.97. Conclusions: DUS is a highly specific tool with excellent diagnostic performance for AA in patients with appendiceal visualization on grayscale US. However, evidence regarding its ability to discriminate between CAA and NCAA remains limited. Given the potential for publication bias, the retrospective design of some included studies, and the presence of moderate to substantial heterogeneity, future multicenter studies with robust methodology and larger sample sizes are warranted to validate these findings.