Efficacy of MRI for the Accurate Diagnosis of Appendicitis in Pregnancy

BACKGROUND AND PURPOSE:

  • Imaging for appendicitis in pregnancy
    • Ultrasound: Significant failure rate due to limited detection capability
    • CT: Used for inconclusive ultrasound results or MRI not available
      • Associated with: Ionizing radiation | Possible allergic reactions to contrast dye
    • MRI: ACR recommended technique for the diagnosis of appendicitis in pregnancy
  • Kave et al. (World Journal of Emergency Surgery, 2019) assessed the efficacy of MRI for the diagnosis of acute appendicitis during pregnancy

METHODS:

  • Systematic review and meta-analysis
  • Inclusion criteria
    • Retrospective and prospective blinded studies
    • Studies that investigated the performance of MRI for suspected appendicitis
  • Data synthesis and analysis
    • Two independent researchers
    • Risk of bias of evaluated
    • Pooled measures: Sensitivity | Specificity | Diagnostic odds ratio (DOR) | Area under the curves (AUC)

RESULTS:

  • 19 studies
  • MRI performance shows high accuracy for detecting appendicitis in pregnancy
    • Sensitivity: 91.8% (95% CI, 87.7 to 94.9%)
    • Specificity: 97.9% (95% CI, 0.97.2 to 100%)
    • DOR: 177.60 (95% CI 35.012–900.91)
  • This study supports MRI as the diagnostic imaging modality of choice due to lack of ionizing radiation and the authors further state

As radiologists become increasingly comfortable with interpreting abdominal and pelvic MRI, and as it becomes more widely available as an emergent procedure, its utility will continue to increase in the future

CONCLUSION:

  • MRI has both high sensitivity and specificity for diagnosing acute appendicitis in pregnant women with suspected appendicitis

Learn More – Primary Sources:

Pregnancy and appendicitis: a systematic review and meta-analysis on the clinical use of MRI in diagnosis of appendicitis in pregnant women