SynthesisAbdominal radiology (New York)2026
Accuracy of magnetic resonance imaging for acute appendicitis in pregnant women: an updated diagnostic systematic review and meta-analysis.
Synthesis in Abdominal radiology (New York), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesDiagnosing acute appendicitis during pregnancy is challenging due to physiological changes and concerns regarding fetal radiation exposure from Computed Tomography (CT). This systematic review and meta-analysis evaluates the diagnostic accuracy and safety of Magnetic Resonance Imaging (MRI) for suspected acute appendicitis, providing an updated synthesis based on a large dataset and modern MRI protocols.
methodsFollowing PRISMA guidelines and PROSPERO registration, we performed a systematic review and diagnostic meta-analysis. Studies involving pregnant women with suspected appendicitis, extractable diagnostic accuracy data (true positives, false positives, false negatives, true negatives), and surgical/histopathological confirmation were included. PubMed, EMBASE, and Cochrane Central were systematically searched until September 3, 2025. Risk of bias was assessed using QUADAS-2, and evidence certainty with GRADE. Statistical analysis used R, employing bivariate random-effects models for sensitivity/specificity, sROC curves, meta-regression, and Deeks' test for publication bias. Thirty-four studies were included.
resultsPooled sensitivity was 0.95 (95% CI: 0.91-0.98; I² = 0%) and pooled specificity 0.97 (95% CI: 0.96-0.98; I² = 55.3%), demonstrating strong diagnostic performance (AUC = 0.961; Diagnostic Odds Ratio = 273.1). A positive MRI result increased post-test probability from 30% to 93%, while a negative result reduced it to 2.2%. QUADAS-2 revealed patient selection and index-test interpretation as common bias sources, particularly in older retrospective studies. Moderate heterogeneity in specificity (I² = 55.3%) was observed, but not explained by gestational age. Deeks' test indicated potential publication bias (p = 0.0024), though pooled estimates remained robust in sensitivity analyses.
conclusionNon-contrast MRI is a highly accurate and safe diagnostic tool for suspected acute appendicitis in pregnancy, demonstrating performance comparable to CT in non-pregnant populations. We recommend MRI as the standard second-line imaging modality following inconclusive ultrasound findings to enhance diagnostic confidence, minimize fetal radiation exposure, and reduce unnecessary surgical interventions.
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