Contemporary ultrasound, computed tomography, or magnetic resonance imaging for acute appendicitis diagnosis in children and adolescents: systematic review and meta-analysis.

Background Advances in ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI) technology and protocols have improved their accuracy for diagnosing acute appendicitis (AP) in children. Objective Determine sensitivity, specificity, and diagnostic odds ratios (DOR) of the latest US, CT, and MRI studies for AP in pediatric patients. Materials and methods PubMed, MEDLINE, BVS, OVID, Web of Science, and Trip Database (Jan 2015-May 2024), were searched for studies in patients 2 to 21 years old with suspected AP. Histopathology and clinical follow-up were the standard tests. Those with insufficient data for a 2x2 contingency table were excluded. QUADAS-2 directed risk of bias assessment. Data were extracted for meta-analysis. Results This systematic review of 37 articles included 22 conventional US studies (20,897 patients), 4 point-of-care US (POCUS) studies (280), 4 CT studies (1,389), and 13 MRI studies (2,630). Pooled sensitivity, specificity and DOR were: conventional US: 0.93 (95%CI [0.87, 0.96]), 0.89 (95%CI [0.80, 0.95]), 115.23 (95%CI [-32.88, 263.34]); POCUS: 0.80 (95%CI [0.61, 0.91]), 0.93 (95%CI [0.83, 0.98]), 53.97 (95%CI [-39, 146.94]); CT: 0.96 (95%CI [0.93, 0.97]), 0.98 (95%CI [0.96, 0.98]), 864.43 (95%CI [264.02, 1,464.84]); MRI: 0.96 (95%CI [0.94, 0.97]), 0.98 (95%CI [0.96, 0.99]), 1,030.42 (95%CI [222.05, 1,838.8]). No statistically significant differences were found (p = 0.07). Discussion Studies were heterogeneous in flow, timing, and follow-up. Nevertheless, all imaging modalities had high diagnostic performance. Conclusion Conventional US is an accurate first-line option; MRI is powerful when available. POCUS may help if it reduces equivocal results, while CT is discouraged due to radiation. Registration PROSPERO: CRD42024538086. May, 5 ^th , 2024. Retrospectively registered. PROSPERO registration name: Ultrasound, computed tomography or magnetic resonance imaging for diagnosing acute appendicitis in children and adolescents.