The diagnostic performance of reduced-dose CT for suspected appendicitis in paediatric and adult patients: A systematic review and diagnostic meta-analysis

• Published in: European radiology 2018-06, Vol.28 (6), p.2537-2548
• Main Authors: Yoon, Hee Mang, Suh, Chong Hyun, Cho, Young Ah, Kim, Jeong Rye, Lee, Jin Seong, Jung, Ah Young, Kim, Jung Heon, Lee, Jeong-Yong, Kim, So Yeon
• Format: Article
• Language: English
• Subjects: Adult; Appendicitis; Appendicitis - diagnostic imaging; Child; Computed tomography; Diagnostic Radiology; Diagnostic systems; Gastrointestinal; Humans; Imaging; Internal Medicine; Interventional Radiology; Logistic Models; Medical diagnosis; Medicine; Medicine & Public Health; Meta-analysis; Neuroradiology; Patients; Radiation; Radiation Dosage; Radiology; Reduction; Regression analysis; Sensitivity; Sensitivity and Specificity; Systematic review; Tomography, X-Ray Computed - methods; Tomography, X-Ray Computed - standards; Ultrasound
• ISSN: 0938-7994; 1432-1084
• DOI: 10.1007/s00330-017-5231-z

Objective To evaluate the diagnostic performance of reduced-dose CT for suspected appendicitis. Methods A systematic search of the MEDLINE and EMBASE databases was carried out through to 10 January 2017. Studies evaluating the diagnostic performance of reduced-dose CT for suspected appendicitis in paediatric and adult patients were selected. Pooled summary estimates of sensitivity and specificity were calculated using hierarchical logistic regression modelling. Meta-regression was performed. Results Fourteen original articles with a total of 3,262 patients were included. For all studies using reduced-dose CT, the summary sensitivity was 96 % (95 % CI 93–98) with a summary specificity of 94 % (95 % CI 92–95). For the 11 studies providing a head-to-head comparison between reduced-dose CT and standard-dose CT, reduced-dose CT demonstrated a comparable summary sensitivity of 96 % (95 % CI 91–98) and specificity of 94 % (95 % CI 93–96) without any significant differences ( p =.41). In meta-regression, there were no significant factors affecting the heterogeneity. The median effective radiation dose of the reduced-dose CT was 1.8 mSv (1.46–4.16 mSv), which was a 78 % reduction in effective radiation dose compared to the standard-dose CT. Conclusion Reduced-dose CT shows excellent diagnostic performance for suspected appendicitis. Key Points • Reduced-dose CT shows excellent diagnostic performance for evaluating suspected appendicitis. • Reduced-dose CT has a comparable diagnostic performance to standard-dose CT. • Median effective radiation dose of reduced-dose CT was 1.8 mSv (1.46–4.16). • Reduced-dose CT achieved a 78 % dose reduction compared to standard-dose CT.