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

Abstract

Background: 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. Methods: The 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. Results: As 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. Conclusion: MRI 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.

Systematic review of Meckel's diverticulum in pregnancy

“…Kave et al report a 91.8% sensitivity and 97.9% specificity of MRI in the diagnosis of appendicitis in pregnant women. 20 In our review, four cases underwent MRI with one of these confirming a diagnosis of MD. MRI may represent a more sensitive modality in the diagnosis of MD in pregnant patients, although this is offset by the duration of scan and resource availability.…”

Acute Appendicitis During Pregnancy: A Case Series of 42 Pregnant Women

“…But in a recent meta-analysis, the diagnostic value of MRI in acute appendicitis was reported to be 96%, with a sensitivity and specificity that was either similar or better than CT [ 18 ]. In obstetric cases, the rate of negative appendectomy in suspected appendicitis cases was reported as 25-50% in another study [ 19 ]. Furthermore, in the current study, the rate of complicated appendicitis in pregnant and non-pregnant women was similar and consistent with the literature [ 20 ].…”

Acute gangrenous appendicitis and acute gangrenous cholecystitis in a pregnant patient, a difficult diagnosis: a case report

“…The diagnosis is made even more difficult by the fact that typical imaging modalities, that is, ultrasound or CT are less sensitive in pregnancy for acute appendicitis (sensitivity 67-100%, specificity 83-96% versus 86 and 96% respectively in nonpregnant population) and controversies exist about contraindications due to potential fetus harm. 6 MRI is the preferred next test in both cases but may not be readily available. In such cases, there may be value in modified CT protocols to minimize the exposure to radiation.…”