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Performance of different scan protocols of fetal echocardiography in the diagnosis of fetal congenital heart disease: a systematic review and meta-analysis.

Li Y, Hua Y, Fang J, Wang C, Qiao L, Wan C, Mu D, Zhou K - PLoS ONE (2013)

Bottom Line: We use results from 81 studies in 63 articles to analyze the pooled accuracy.Unfortunately the pooled specificity of STIC was 0.92, which was significant lower than that of other 4 protocols which reached at 1.00.But at least 3 sections view (4 CV, OTV and 3 VTV) should be included in scan protocol, while the STIC can be used to provide more information for local details of defects, and can not be used to make a definite diagnosis alone with its low specificity.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatric Cardiovascular Disease, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.

ABSTRACT

Objective: The rapid progress in fetal echocardiography has lead to early detection of congenital heart diseases. Increasing evidences have shown that prenatal diagnosis could be life saving in certain cases. However, there is no agreement on which protocol is most adaptive diagnostic one. Thus, we use meta-analysis to conduct a pooled performance test on 5 diagnostic protocols.

Methods: We searched PUBMED, EMBASE, the Cochrane Central Register of Controlled Trials and WHO clinical trails registry center to identify relevant studies up to August, 2012. We performed meta-analysis in a fixed/random-effect model using Meta-disc 1.4. We used STATA 11.0 to estimate the publication bias and SPSS 17.0 to evaluate variance.

Results: We use results from 81 studies in 63 articles to analyze the pooled accuracy. The overall performance of pooled sensitivities of spatiotemporal image correlation (STIC), extend cardiac echography examination (ECEE) and 4 chambers view + outflow tract view + 3 vessels and trachea view (4 CV+OTV+3 VTV) were around 0.90, which was significant higher than that of 4 chambers view + outflow tract view or 3 vessels and trachea view (4 CV+OTV/3 VTV) and 4 chambers view (4 CV). Unfortunately the pooled specificity of STIC was 0.92, which was significant lower than that of other 4 protocols which reached at 1.00. The area under the summary receiver operating characteristic curves value of STIC, ECEE, 4 CV+OTV+3 VTV, 4 CV+OTV/3 VTV and 4 CV were 0.9700, 0.9971, 0.9983, 0.9929 and 0.9928 respectively.

Conclusion: These results suggest a great diagnostic potential for fetal echocardiography detection as a reliable method of fetal congenital heart disease. But at least 3 sections view (4 CV, OTV and 3 VTV) should be included in scan protocol, while the STIC can be used to provide more information for local details of defects, and can not be used to make a definite diagnosis alone with its low specificity.

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Overall diagnostic odds ratio and summary receiver operating characteristic curves for all data sets describing the diagnostic performance of STIC detection in identifying fetal CHDs.(A) Overall diagnostic odds ratio. (B) The summary receiver operating characteristic curves for all data sets. Effect sizes were pooled by random-effects models. The pooled diagnostic odds ratio is shown as a solid diamond. Each square in the summary receiver operating characteristic curve represents one study. Sample size is indicated by the size of the square. STIC, spatiotemporal image correlation; CI, confidence interval; df, degrees of freedom; DOR, diagnostic odds ratio; AUC, area under curve.
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pone-0065484-g003: Overall diagnostic odds ratio and summary receiver operating characteristic curves for all data sets describing the diagnostic performance of STIC detection in identifying fetal CHDs.(A) Overall diagnostic odds ratio. (B) The summary receiver operating characteristic curves for all data sets. Effect sizes were pooled by random-effects models. The pooled diagnostic odds ratio is shown as a solid diamond. Each square in the summary receiver operating characteristic curve represents one study. Sample size is indicated by the size of the square. STIC, spatiotemporal image correlation; CI, confidence interval; df, degrees of freedom; DOR, diagnostic odds ratio; AUC, area under curve.

Mentions: Overall diagnostic performance of STIC (Figure 2 and 3) shows the capability of STIC in detecting fetal CHD. The summary sensitivity was 0.90 (95% CI, 0.87 to 0.93), with individual sensitivities ranging from 0.70 to 1.00. The summary specificity was 0.92 (95% CI, 0.90 to 0.94), with individual specificities ranging from 0.46 to 0.99. Both pooled estimations showed significant heterogeneity (Sensitivity: P = 0.0100, X2 = 18.47, I2 = 62.1%; specificity: P = 0.0000, X2 = 61.75, I2 = 88.7%). The pooled diagnostic odds ratio was 131.65 (95% CI, 44.62 to 388.50), with individual diagnostic odds ratio s ranging from 5.14 to 1267.00. The results of diagnostic odds ratio showed no consistency across the included reports, with noticeable heterogeneity (P = 0.0005, Cochran-Q = 26.14, I2 = 73.2%). The point size in the summary receiver operating characteristic curve represented the proportional study weight. Most data gathered near the top left corner where sensitivity and specificity were both the highest. The the area under the curve value was 0.9700±0.0126. The absence of curvilinear shape in the summary receiver operating characteristic curve suggested no potential presence of a threshold effect.


Performance of different scan protocols of fetal echocardiography in the diagnosis of fetal congenital heart disease: a systematic review and meta-analysis.

Li Y, Hua Y, Fang J, Wang C, Qiao L, Wan C, Mu D, Zhou K - PLoS ONE (2013)

Overall diagnostic odds ratio and summary receiver operating characteristic curves for all data sets describing the diagnostic performance of STIC detection in identifying fetal CHDs.(A) Overall diagnostic odds ratio. (B) The summary receiver operating characteristic curves for all data sets. Effect sizes were pooled by random-effects models. The pooled diagnostic odds ratio is shown as a solid diamond. Each square in the summary receiver operating characteristic curve represents one study. Sample size is indicated by the size of the square. STIC, spatiotemporal image correlation; CI, confidence interval; df, degrees of freedom; DOR, diagnostic odds ratio; AUC, area under curve.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3672155&req=5

pone-0065484-g003: Overall diagnostic odds ratio and summary receiver operating characteristic curves for all data sets describing the diagnostic performance of STIC detection in identifying fetal CHDs.(A) Overall diagnostic odds ratio. (B) The summary receiver operating characteristic curves for all data sets. Effect sizes were pooled by random-effects models. The pooled diagnostic odds ratio is shown as a solid diamond. Each square in the summary receiver operating characteristic curve represents one study. Sample size is indicated by the size of the square. STIC, spatiotemporal image correlation; CI, confidence interval; df, degrees of freedom; DOR, diagnostic odds ratio; AUC, area under curve.
Mentions: Overall diagnostic performance of STIC (Figure 2 and 3) shows the capability of STIC in detecting fetal CHD. The summary sensitivity was 0.90 (95% CI, 0.87 to 0.93), with individual sensitivities ranging from 0.70 to 1.00. The summary specificity was 0.92 (95% CI, 0.90 to 0.94), with individual specificities ranging from 0.46 to 0.99. Both pooled estimations showed significant heterogeneity (Sensitivity: P = 0.0100, X2 = 18.47, I2 = 62.1%; specificity: P = 0.0000, X2 = 61.75, I2 = 88.7%). The pooled diagnostic odds ratio was 131.65 (95% CI, 44.62 to 388.50), with individual diagnostic odds ratio s ranging from 5.14 to 1267.00. The results of diagnostic odds ratio showed no consistency across the included reports, with noticeable heterogeneity (P = 0.0005, Cochran-Q = 26.14, I2 = 73.2%). The point size in the summary receiver operating characteristic curve represented the proportional study weight. Most data gathered near the top left corner where sensitivity and specificity were both the highest. The the area under the curve value was 0.9700±0.0126. The absence of curvilinear shape in the summary receiver operating characteristic curve suggested no potential presence of a threshold effect.

Bottom Line: We use results from 81 studies in 63 articles to analyze the pooled accuracy.Unfortunately the pooled specificity of STIC was 0.92, which was significant lower than that of other 4 protocols which reached at 1.00.But at least 3 sections view (4 CV, OTV and 3 VTV) should be included in scan protocol, while the STIC can be used to provide more information for local details of defects, and can not be used to make a definite diagnosis alone with its low specificity.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatric Cardiovascular Disease, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.

ABSTRACT

Objective: The rapid progress in fetal echocardiography has lead to early detection of congenital heart diseases. Increasing evidences have shown that prenatal diagnosis could be life saving in certain cases. However, there is no agreement on which protocol is most adaptive diagnostic one. Thus, we use meta-analysis to conduct a pooled performance test on 5 diagnostic protocols.

Methods: We searched PUBMED, EMBASE, the Cochrane Central Register of Controlled Trials and WHO clinical trails registry center to identify relevant studies up to August, 2012. We performed meta-analysis in a fixed/random-effect model using Meta-disc 1.4. We used STATA 11.0 to estimate the publication bias and SPSS 17.0 to evaluate variance.

Results: We use results from 81 studies in 63 articles to analyze the pooled accuracy. The overall performance of pooled sensitivities of spatiotemporal image correlation (STIC), extend cardiac echography examination (ECEE) and 4 chambers view + outflow tract view + 3 vessels and trachea view (4 CV+OTV+3 VTV) were around 0.90, which was significant higher than that of 4 chambers view + outflow tract view or 3 vessels and trachea view (4 CV+OTV/3 VTV) and 4 chambers view (4 CV). Unfortunately the pooled specificity of STIC was 0.92, which was significant lower than that of other 4 protocols which reached at 1.00. The area under the summary receiver operating characteristic curves value of STIC, ECEE, 4 CV+OTV+3 VTV, 4 CV+OTV/3 VTV and 4 CV were 0.9700, 0.9971, 0.9983, 0.9929 and 0.9928 respectively.

Conclusion: These results suggest a great diagnostic potential for fetal echocardiography detection as a reliable method of fetal congenital heart disease. But at least 3 sections view (4 CV, OTV and 3 VTV) should be included in scan protocol, while the STIC can be used to provide more information for local details of defects, and can not be used to make a definite diagnosis alone with its low specificity.

Show MeSH
Related in: MedlinePlus