Die diagnostische Richtigkeit von CT und MRT bei V.a. akute Appendizitis-eine Metaanalyse-

Diagnosis of acute appendicitis is still a major problem. Despite improvements in history-taking and clinical examination and the increased availability of diagnostic technologies such as ultrasonography and computed tomography there are still reports of error rates up to 20%. The aim of this dissertation was to assess the diagnostic value and determine the diagnostic accuracy of computed tomography and magnetic resonance imaging in patients suspected of having acute appendicitis. A literature search with predefined keywords and inclusion and exclusion criteria was performed in PubMed and reference lists were hand searched. Two researchers assessed independently the quality of the diagnostic trials. If they disagreed, a third expert was consulted. Then a meta-analysis of the included trials was performed. A bivariate analysis was used in order to account for the twodimensional character and possible negative correlation of sensitivity and specificity to determine overall sensitivity and specificity. The search identified 86 trials with a total of 12369 patients evaluating computed tomography and 6 trials (203 patients) evaluating magnetic resonance imaging in the diagnosis of acute appendicitis. The pooled sensitivity and specificity of the included trials on computed tomography were 93.7% (95% confidence interval: 92.2%-95.0%) and 90.7% (95% CI: 87.5%-93.2%). Subgroup of trials with excellent quality scores or publications in journals with high impact factor (greater 3) gave similar results for diagnostic accuracy. Comparison of focused and nonfocused CT scans showed that focused CT had a significant higher specificity with identical sensitivity. Magnetic resonance imaging had a pooled sensitivity and specificity of 92.5% (95% CI: 80.6%-97.3%) and 89.1% (95% CI: 83.4%-93.0%). This meta-analysis showed a good performance of CT and MRI for acute appendicitis.