当代超声、计算机断层扫描或磁共振成像用于儿童和青少年急性阑尾炎诊断的系统评价和荟萃分析。
Contemporary ultrasound, computed tomography, or magnetic resonance imaging for acute appendicitis diagnosis in children and adolescents: systematic review and meta-analysis.
作者信息
Castro-Luna Diana Isabel, Porras-Hernandez Juan D, Flores-Garcia Jose Andres, Dies-Suarez Pilar, Servin-Martinez Maria Fernanda, Pierdant-Perez Mauricio
机构信息
Antala Kune, Hospital Angeles, Puebla, Mexico, Av Kepler 2143, Torre 4, Piso 6, 3645, Puebla, 72190, Mexico.
Autonomous University of San Luis Potosí, San Luis Potosí City, Mexico.
出版信息
Pediatr Radiol. 2025 May 9. doi: 10.1007/s00247-025-06261-y.
BACKGROUND
Since the last publication of meta-analyses on pediatric acute appendicitis imaging in 2016 and 2018, ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI) technology and protocols have improved, and there are new reports on their accuracy.
OBJECTIVE
We determined sensitivity, specificity, and diagnostic odds ratios (DOR) of the US, CT, and MRI for pediatric acute appendicitis, in studies published from 2015 to 2024.
MATERIALS AND METHODS
PubMed, MEDLINE, BVS, OVID, Web of Science, and Trip Database (Jan 2015-May 2024) were searched for studies in patients less than 21 years old with suspected acute appendicitis. Histopathology and clinical follow-up were the reference standard. Those with insufficient data for a 2 × 2 contingency table were excluded. QUADAS-2 directed risk of bias assessment. Data were extracted for meta-analysis.
RESULTS
Our 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). For quantitative synthesis, US and POCUS studies had the highest heterogeneity.
CONCLUSION
All four modalities have high diagnostic accuracy.
REGISTRATION
PROSPERO: CRD42024538086. May 5, 2024. Retrospectively registered. PROSPERO registration name: Ultrasound, computed tomography or magnetic resonance imaging for diagnosing acute appendicitis in children and adolescents.
背景
自2016年和2018年上次发表关于小儿急性阑尾炎影像学的荟萃分析以来，超声（US）、计算机断层扫描（CT）和磁共振成像（MRI）技术及方案已有所改进，并且有关于其准确性的新报告。
目的
我们在2015年至2024年发表的研究中，确定了US、CT和MRI对小儿急性阑尾炎的敏感性、特异性和诊断比值比（DOR）。
材料与方法
检索了PubMed、MEDLINE、BVS、OVID、科学网和Trip数据库（2015年1月至2024年5月）中关于疑似急性阑尾炎的21岁以下患者的研究。组织病理学和临床随访为参考标准。排除那些数据不足以构建2×2列联表的研究。采用QUADAS - 2进行偏倚风险评估。提取数据进行荟萃分析。
结果
我们对37篇文章的综述包括22项传统US研究（20897例患者）、4项床旁超声（POCUS）研究（280例）、4项CT研究（1389例）和13项MRI研究（2630例）。汇总的敏感性、特异性和DOR分别为：传统US：0.93（95%CI[0.87, 0.96]），0.89（95%CI[0.80, 0.95]），115.23（9 %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, 1464.84]）；MRI：0.96（95%CI[0.94, 0.97]），0.98（95%CI[0.96, 0.99]），1030.42（95%CI[222.05, 1838.8]）。未发现统计学显著差异（P = 0.07）。对于定量合成，US和POCUS研究的异质性最高。
结论
所有四种检查方式均具有较高的诊断准确性。
注册情况
PROSPERO：CRD42024538086。2024年5月5日。回顾性注册。PROSPERO注册名称：超声、计算机断层扫描或磁共振成像用于诊断儿童和青少年急性阑尾炎。
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