Skip to main content
Top
Published in: Pediatric Radiology 2/2017

01-02-2017 | Original Article

Ultrasound, computed tomography or magnetic resonance imaging - which is preferred for acute appendicitis in children? A Meta-analysis

Authors: Hanfei Zhang, Meiyan Liao, Jie Chen, Dongyong Zhu, Sama Byanju

Published in: Pediatric Radiology | Issue 2/2017

Login to get access

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.
Literature
1.
go back to reference 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 67:83–86CrossRefPubMedPubMedCentral 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 67:83–86CrossRefPubMedPubMedCentral
2.
go back to reference Addiss DG, Shaffer N, Fowler BS et al (1990) The epidemiology of appendicitis and appendectomy in the United States. Am J Epidemiol 132:910–925PubMed Addiss DG, Shaffer N, Fowler BS et al (1990) The epidemiology of appendicitis and appendectomy in the United States. Am J Epidemiol 132:910–925PubMed
3.
go back to reference Körner H, Söndenaa K, Söreide JA et al (2000) The history is important in patients with suspected acute appendicitis. Dig Surg 17:364–368CrossRefPubMed Körner H, Söndenaa K, Söreide JA et al (2000) The history is important in patients with suspected acute appendicitis. Dig Surg 17:364–368CrossRefPubMed
4.
5.
go back to reference Puylaert JB (1986) Acute appendicitis: US evaluation using graded compression. Radiology 158:355–360CrossRefPubMed Puylaert JB (1986) Acute appendicitis: US evaluation using graded compression. Radiology 158:355–360CrossRefPubMed
7.
go back to reference Malone AJ Jr, Wolf CR, Malmed AS et al (1993) Diagnosis of acute appendicitis: value of unenhanced CT. AJR Am J Roentgenol 160:763–766CrossRefPubMed Malone AJ Jr, Wolf CR, Malmed AS et al (1993) Diagnosis of acute appendicitis: value of unenhanced CT. AJR Am J Roentgenol 160:763–766CrossRefPubMed
8.
go back to reference 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 185:406–417CrossRefPubMed 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 185:406–417CrossRefPubMed
9.
go back to reference Brenner D, Elliston C, Hall E et al (2001) Estimated risks of radiation-induced fatal cancer from pediatric CT. AJR Am J Roentgenol 176:289–296CrossRefPubMed Brenner D, Elliston C, Hall E et al (2001) Estimated risks of radiation-induced fatal cancer from pediatric CT. AJR Am J Roentgenol 176:289–296CrossRefPubMed
10.
go back to reference Orth RC, Guillerman RP, Zhang W et al (2015) Prospective comparison of MR imaging and US for the diagnosis of pediatric appendicitis. Radiology 272:233–240CrossRef Orth RC, Guillerman RP, Zhang W et al (2015) Prospective comparison of MR imaging and US for the diagnosis of pediatric appendicitis. Radiology 272:233–240CrossRef
11.
go back to reference Thieme ME, Leeuwenburgh MM, Valdehueza ZD et al (2014) Diagnostic accuracy and patient acceptance of MRI in children with suspected appendicitis. Eur Radiol 24:630–637CrossRefPubMed Thieme ME, Leeuwenburgh MM, Valdehueza ZD et al (2014) Diagnostic accuracy and patient acceptance of MRI in children with suspected appendicitis. Eur Radiol 24:630–637CrossRefPubMed
12.
13.
go back to reference Moore MM, Gustas CN, Choudhary AK et al (2012) MRI for clinically suspected pediatric appendicitis: an implemented program. Pediatr Radiol 42:1056–1063CrossRefPubMed Moore MM, Gustas CN, Choudhary AK et al (2012) MRI for clinically suspected pediatric appendicitis: an implemented program. Pediatr Radiol 42:1056–1063CrossRefPubMed
14.
go back to reference Moher D, Liberati A, Tetzlaff J et al (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 21:b2535CrossRef Moher D, Liberati A, Tetzlaff J et al (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 21:b2535CrossRef
15.
go back to reference 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 19:455–461CrossRefPubMed 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 19:455–461CrossRefPubMed
16.
go back to reference 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 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
17.
go back to reference 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 202:139–144CrossRefPubMed 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 202:139–144CrossRefPubMed
18.
go back to reference 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 155:529–536CrossRefPubMed 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 155:529–536CrossRefPubMed
19.
go back to reference 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 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
20.
go back to reference 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 58:882–893CrossRefPubMed 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 58:882–893CrossRefPubMed
21.
go back to reference Kaiser S, Frenckner B, Jorulf HK (2002) Suspected appendicitis in children: US and CT--a prospective randomized study. Radiology 233:633–638CrossRef Kaiser S, Frenckner B, Jorulf HK (2002) Suspected appendicitis in children: US and CT--a prospective randomized study. Radiology 233:633–638CrossRef
22.
go back to reference 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 175:1387–1392CrossRefPubMed 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 175:1387–1392CrossRefPubMed
23.
go back to reference Baldisserotto M, Peletti AB (2007) Is colour Doppler sonography a good method to differentiate normal and abnormal appendices in children? Clin Radiol 62:365–369CrossRefPubMed Baldisserotto M, Peletti AB (2007) Is colour Doppler sonography a good method to differentiate normal and abnormal appendices in children? Clin Radiol 62:365–369CrossRefPubMed
24.
go back to reference Binkovitz LA, Unsdorfer KM, Thapa P et al (2015) Pediatric appendiceal ultrasound: accuracy, determinacy and clinical outcomes. Pediatr Radiol 45:1934–1944CrossRefPubMed Binkovitz LA, Unsdorfer KM, Thapa P et al (2015) Pediatric appendiceal ultrasound: accuracy, determinacy and clinical outcomes. Pediatr Radiol 45:1934–1944CrossRefPubMed
25.
go back to reference Burford JM, Dassinger MS, Smith SD (2011) Surgeon-performed ultrasound as a diagnostic tool in appendicitis. J Pediatr Surg 46:1115–1120CrossRefPubMed Burford JM, Dassinger MS, Smith SD (2011) Surgeon-performed ultrasound as a diagnostic tool in appendicitis. J Pediatr Surg 46:1115–1120CrossRefPubMed
26.
go back to reference Chang YJ, Kong MS, Hsia SH et al (2007) Usefulness of ultrasonography in acute appendicitis in early childhood. J Pediatr Gastroenterol Nutr 44:592–595CrossRefPubMed Chang YJ, Kong MS, Hsia SH et al (2007) Usefulness of ultrasonography in acute appendicitis in early childhood. J Pediatr Gastroenterol Nutr 44:592–595CrossRefPubMed
27.
go back to reference Hahn HB, Hoepner FU, Kalle T et al (1998) Sonography of acute appendicitis in children: 7 years experience. Pediatr Radiol 28:147–151CrossRefPubMed Hahn HB, Hoepner FU, Kalle T et al (1998) Sonography of acute appendicitis in children: 7 years experience. Pediatr Radiol 28:147–151CrossRefPubMed
28.
go back to reference Limchareon S, Wongsuttilert A, Boonyarit A (2014) Efficacy of ultrasonography in the evaluation of suspected appendicitis in a pediatric population. J Med Ultrasound 22:213–217CrossRef Limchareon S, Wongsuttilert A, Boonyarit A (2014) Efficacy of ultrasonography in the evaluation of suspected appendicitis in a pediatric population. J Med Ultrasound 22:213–217CrossRef
29.
go back to reference 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 176:31–35CrossRefPubMed 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 176:31–35CrossRefPubMed
30.
go back to reference 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 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
31.
go back to reference Peña BM, Taylor GA (2000) Radiologists' confidence in interpretation of sonography and CT in suspected pediatric appendicitis. AJR Am J Roentgenol 175:71–74CrossRefPubMed Peña BM, Taylor GA (2000) Radiologists' confidence in interpretation of sonography and CT in suspected pediatric appendicitis. AJR Am J Roentgenol 175:71–74CrossRefPubMed
32.
33.
go back to reference Schulte B, Beyer D, Kaiser C et al (1998) Ultrasonography in suspected acute appendicitis in childhood-report of 1285 cases. Eur J Ultrasound 8:177–182CrossRefPubMed Schulte B, Beyer D, Kaiser C et al (1998) Ultrasonography in suspected acute appendicitis in childhood-report of 1285 cases. Eur J Ultrasound 8:177–182CrossRefPubMed
34.
go back to reference 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 41:387–392PubMed 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 41:387–392PubMed
35.
go back to reference 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 12:69–74CrossRef 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 12:69–74CrossRef
36.
go back to reference Toprak H, Kilincaslan H, Ahmad IC et al (2014) Integration of ultrasound findings with Alvarado score in children with suspected appendicitis. Pediatr Int 56:95–99CrossRefPubMed Toprak H, Kilincaslan H, Ahmad IC et al (2014) Integration of ultrasound findings with Alvarado score in children with suspected appendicitis. Pediatr Int 56:95–99CrossRefPubMed
37.
go back to reference van Atta AJ, Baskin HJ, Maves CK et al (2015) Implementing an ultrasound-based protocol for diagnosing appendicitis while maintaining diagnostic accuracy. Pediatr Radiol 45:678–685CrossRefPubMed van Atta AJ, Baskin HJ, Maves CK et al (2015) Implementing an ultrasound-based protocol for diagnosing appendicitis while maintaining diagnostic accuracy. Pediatr Radiol 45:678–685CrossRefPubMed
38.
go back to reference 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 61:474–476PubMed 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 61:474–476PubMed
39.
go back to reference Didier RA, Vajtai PL, Hopkins KL (2015) Iterative reconstruction technique with reduced volume CT dose index: diagnostic accuracy in pediatric acute appendicitis. Pediatr Radiol 45:181–187CrossRefPubMed Didier RA, Vajtai PL, Hopkins KL (2015) Iterative reconstruction technique with reduced volume CT dose index: diagnostic accuracy in pediatric acute appendicitis. Pediatr Radiol 45:181–187CrossRefPubMed
40.
go back to reference Fefferman NR, Roche KJ, Pinkney LP et al (2001) Suspected appendicitis in children: focused CT technique for evaluation. Radiology 220:691–695CrossRefPubMed Fefferman NR, Roche KJ, Pinkney LP et al (2001) Suspected appendicitis in children: focused CT technique for evaluation. Radiology 220:691–695CrossRefPubMed
41.
go back to reference Hoecker CC, Billman GF (2005) The utility of unenhanced computed tomography in appendicitis in children. J Emerg Med 28:415–421CrossRefPubMed Hoecker CC, Billman GF (2005) The utility of unenhanced computed tomography in appendicitis in children. J Emerg Med 28:415–421CrossRefPubMed
42.
go back to reference Sivit CJ, Applegate KE, Berlin SC et al (2000) Evaluation of suspected appendicitis in children and young adults: helical CT. Radiology 216:430–433CrossRefPubMed Sivit CJ, Applegate KE, Berlin SC et al (2000) Evaluation of suspected appendicitis in children and young adults: helical CT. Radiology 216:430–433CrossRefPubMed
43.
go back to reference 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 198:1424–1430CrossRefPubMed 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 198:1424–1430CrossRefPubMed
44.
go back to reference 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 50:1359–1363CrossRefPubMed 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 50:1359–1363CrossRefPubMed
45.
go back to reference Nitta N, Takahashi M, Furukawa A et al (2005) MR imaging of the normal appendix and acute appendicitis. J Magn Reson Imaging 21:156–165CrossRefPubMed Nitta N, Takahashi M, Furukawa A et al (2005) MR imaging of the normal appendix and acute appendicitis. J Magn Reson Imaging 21:156–165CrossRefPubMed
46.
go back to reference Aspelund G, Fingeret A, Gross E et al (2014) Ultrasonography/MRI versus CT for diagnosing appendicitis. Pediatrics 133:586–593CrossRefPubMed Aspelund G, Fingeret A, Gross E et al (2014) Ultrasonography/MRI versus CT for diagnosing appendicitis. Pediatrics 133:586–593CrossRefPubMed
47.
go back to reference 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 200:969–973CrossRefPubMed 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 200:969–973CrossRefPubMed
48.
go back to reference Doria AS, Moineddin R, Kellenberger CJ et al (2006) US or CT for diagnosis of appendicitis in children and adults? A meta-analysis. Radiology 241:83–94CrossRefPubMed Doria AS, Moineddin R, Kellenberger CJ et al (2006) US or CT for diagnosis of appendicitis in children and adults? A meta-analysis. Radiology 241:83–94CrossRefPubMed
49.
go back to reference Callahan MJ, Rodriguez DP, Taylor GA (2002) CT of appendicitis in children. Radiology 224:325–332CrossRefPubMed Callahan MJ, Rodriguez DP, Taylor GA (2002) CT of appendicitis in children. Radiology 224:325–332CrossRefPubMed
50.
go back to reference Hernandez JA, Swischuk LE, Angel CA et al (2005) Imaging of acute appendicitis: US as the primary imaging modality. Pediatr Radiol 35:392–395CrossRefPubMed Hernandez JA, Swischuk LE, Angel CA et al (2005) Imaging of acute appendicitis: US as the primary imaging modality. Pediatr Radiol 35:392–395CrossRefPubMed
51.
go back to reference Rosendahl K, Aukland SM, Fosse K (2004) Imaging strategies in children with suspected appendicitis. Eur Radiol 14:L138–L145CrossRefPubMed Rosendahl K, Aukland SM, Fosse K (2004) Imaging strategies in children with suspected appendicitis. Eur Radiol 14:L138–L145CrossRefPubMed
52.
go back to reference Irish MS, Pearl RH, Caty MG et al (1998) The approach to common abdominal diagnosis in infants and children. Pediatr Clin N Am 45:729–772CrossRef Irish MS, Pearl RH, Caty MG et al (1998) The approach to common abdominal diagnosis in infants and children. Pediatr Clin N Am 45:729–772CrossRef
Metadata
Title
Ultrasound, computed tomography or magnetic resonance imaging - which is preferred for acute appendicitis in children? A Meta-analysis
Authors
Hanfei Zhang
Meiyan Liao
Jie Chen
Dongyong Zhu
Sama Byanju
Publication date
01-02-2017
Publisher
Springer Berlin Heidelberg
Published in
Pediatric Radiology / Issue 2/2017
Print ISSN: 0301-0449
Electronic ISSN: 1432-1998
DOI
https://doi.org/10.1007/s00247-016-3727-3

Other articles of this Issue 2/2017

Pediatric Radiology 2/2017 Go to the issue