Introduction. Appendicitis is the most common condition requiring acute abdominal surgery in children. Clinical diagnosis of acute appendicitis (AA) is not always straightforward, and abdominal ultrasound is specific but insufficiently sensitive. Computed tomography (CT) has become favored but its use in children is discouraged due to ionizing radiation exposure. Therefore, magnetic resonance imaging (MRI) is considered an alternative. Aim of the study. This study aims to compare the accuracy of MRI with that of CT for the diagnosis of AA in pediatric patients. Materials and methods. For this systematic review, a search of the PubMed database was conducted to select studies that used MRI for diagnosing pediatric patients with suspected appendicitis. Studies that focused on evaluating the accuracy of MRI to diagnose appendicitis were included. Studies with insufficient data to calculate the outcomes were excluded, as well as those older than ten years. Data for sensitivity and specificity of MRI were extracted from the studies, then, using Barnard’s exact test, tested for significance compared to sensitivity and specificity of CT. ____________________________________________________________________________________ 196 Results. Eleven studies met eligibility criteria and were relevant to the question of this systematic review. Sensitivity and specificity were 0.96 (0.95–0.97) and 0.96 (0.94–0.98) for MRI, as compared to 0.94 (0.92-0.97) and 0.95 (0.94-0.97) for CT (with 95% CI). Conclusions. The authors concluded that the accuracies of MRI and CT for the diagnosis of AA in pediatric patients are very similar, without any statistically significant difference in accuracy. Therefore, MRI constitutes a viable and safer approach to diagnosing AA due to its sensitivity, specificity and lack of exposure to radiation.