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Diagnostic accuracy of computed tomography for chronic thromboembolic pulmonary hypertension: a systematic review and meta-analysis.

Dong C, Zhou M, Liu D, Long X, Guo T, Kong X - PLoS ONE (2015)

Bottom Line: This resulted in a pooled diagnostic odds ratio (DOR) of 191 (95%CI: 75 to 486).This resulted in a pooled diagnostic odds ratio of 76 (95%CI: 23 to 254),751 (95%CI: 57 to 9905) and 189 (95%CI: 21 to 1072), respectively.In the near future, CT could position itself as the key for screening consideration and for surgical and interventional operability.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China.

ABSTRACT
This study aimed to determine the diagnostic accuracy of computed tomography imaging for the diagnosis of chronic thromboembolic pulmonary hypertension (CTEPH). Additionally, the effect of test and study characteristics was explored. Studies published between 1990 and 2015 identified by PubMed, OVID search and citation tracking were examined. Of the 613 citations, 11 articles (n=712) met the inclusion criteria. The patient-based analysis demonstrated a pooled sensitivity of 76% (95% confidence interval [CI]: 69% to 82%), and a pooled specificity of 96% (95%CI: 93% to 98%). This resulted in a pooled diagnostic odds ratio (DOR) of 191 (95%CI: 75 to 486). The vessel-based analyses were divided into 3 levels: total arteries、main+ lobar arteries and segmental arteries. The pooled sensitivity were 88% (95%CI: 87% to 90%)、95% (95%CI: 92% to 97%) and 88% (95%CI: 87% to 90%), respectively, with a pooled specificity of 90% (95%CI: 88% to 91%)、96% (95%CI: 94% to 97%) and 89% (95% CI: 87% to 91%). This resulted in a pooled diagnostic odds ratio of 76 (95%CI: 23 to 254),751 (95%CI: 57 to 9905) and 189 (95%CI: 21 to 1072), respectively. In conclusion, CT is a favorable method to rule in CTEPH and to rule out pulmonary endarterectomy (PEA) patients for proximal branches. Furthermore, dual-energy and 320-slices CT can increase the sensitivity for subsegmental arterials, which are promising imaging techniques for balloon pulmonary angioplasty (BPA) approach. In the near future, CT could position itself as the key for screening consideration and for surgical and interventional operability.

No MeSH data available.


Related in: MedlinePlus

Summary ROC curve for CT.Diagnostic performance of CT in (A) patient basis; (B) total arteries; (C) main + lobar arteries; (D) segmental arteries.
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pone.0126985.g005: Summary ROC curve for CT.Diagnostic performance of CT in (A) patient basis; (B) total arteries; (C) main + lobar arteries; (D) segmental arteries.

Mentions: Forest plots of sensitivity and specificity were shown in Figs 3 and 4. The patient-based analyses demonstrated a moderate sensitivity of 76% (95% CI: 69% to 82%, I2 = 93.8%, p<0.01) and a high specificity of 96% (95%CI: 93% to 98%, I2 = 75.2%, p<0.01). The vessel-based analyses were divided into three levels: total arteries、main+ lobar arteries and segmental arteries. The more peripheral areas the emboli located, the lower the sensitivity and specificity were. The pooled sensitivity were 88% (95%CI: 87% to 90%)、95% (95%CI: 92% to 97%) and 88% (95%CI: 87% to 90%), respectively. And the pooled specificity were 90% (95%CI: 88% to 91%)、96% (95%CI: 94% to 97%) and 89% (95% CI: 87% to 91%), correspondently. SOC curves of CT on both patient and vessel basis were in Fig 5. The area under the curves was 0.9780, 0.9573, 0.9929 and 0.9741, respectively. There was significant heterogeneity across the studies on both patient and vessel basis. Subgroup analyses were performed to explore all possible sources of heterogeneity (Table 3). The analyses revealed no significant effect of study characteristics on the diagnostic performance of CT, except for a lower pooled DOR of CT in poor-quality studies compared with high-quality studies in overall arterials on vessel basis. We classified studies into 2 categories depending upon the methodological quality: high-quality studies (Ref. 19, 23, 24) and poor-quality studies (Ref. 1, 22, 26, 27). A study was judged poor-quality if it was judged "high risk of bias" in 2 or more domains. Additionally, in vessel level, promising CT (320-slices CT and dual-energy CT) demonstrated a higher but non-significant DOR in comparison to routine CT (64 or less slices CT). Sensitivity analysis demonstrated that pooled estimate did not change with exclusion of any 1 study (Table 4). The post-test probability on patient-based analysis showed that CT has a favorable positive post-test probability over a wide range of pre-test probabilities, which can be applied to rule in the disease (Fig 6). The value of PPV and NPV was 90.6% and 87% in total arteries, 92.8% and 97% in main + lobar arteries and 89% and 89% in segmental arteries, respectively.


Diagnostic accuracy of computed tomography for chronic thromboembolic pulmonary hypertension: a systematic review and meta-analysis.

Dong C, Zhou M, Liu D, Long X, Guo T, Kong X - PLoS ONE (2015)

Summary ROC curve for CT.Diagnostic performance of CT in (A) patient basis; (B) total arteries; (C) main + lobar arteries; (D) segmental arteries.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4414539&req=5

pone.0126985.g005: Summary ROC curve for CT.Diagnostic performance of CT in (A) patient basis; (B) total arteries; (C) main + lobar arteries; (D) segmental arteries.
Mentions: Forest plots of sensitivity and specificity were shown in Figs 3 and 4. The patient-based analyses demonstrated a moderate sensitivity of 76% (95% CI: 69% to 82%, I2 = 93.8%, p<0.01) and a high specificity of 96% (95%CI: 93% to 98%, I2 = 75.2%, p<0.01). The vessel-based analyses were divided into three levels: total arteries、main+ lobar arteries and segmental arteries. The more peripheral areas the emboli located, the lower the sensitivity and specificity were. The pooled sensitivity were 88% (95%CI: 87% to 90%)、95% (95%CI: 92% to 97%) and 88% (95%CI: 87% to 90%), respectively. And the pooled specificity were 90% (95%CI: 88% to 91%)、96% (95%CI: 94% to 97%) and 89% (95% CI: 87% to 91%), correspondently. SOC curves of CT on both patient and vessel basis were in Fig 5. The area under the curves was 0.9780, 0.9573, 0.9929 and 0.9741, respectively. There was significant heterogeneity across the studies on both patient and vessel basis. Subgroup analyses were performed to explore all possible sources of heterogeneity (Table 3). The analyses revealed no significant effect of study characteristics on the diagnostic performance of CT, except for a lower pooled DOR of CT in poor-quality studies compared with high-quality studies in overall arterials on vessel basis. We classified studies into 2 categories depending upon the methodological quality: high-quality studies (Ref. 19, 23, 24) and poor-quality studies (Ref. 1, 22, 26, 27). A study was judged poor-quality if it was judged "high risk of bias" in 2 or more domains. Additionally, in vessel level, promising CT (320-slices CT and dual-energy CT) demonstrated a higher but non-significant DOR in comparison to routine CT (64 or less slices CT). Sensitivity analysis demonstrated that pooled estimate did not change with exclusion of any 1 study (Table 4). The post-test probability on patient-based analysis showed that CT has a favorable positive post-test probability over a wide range of pre-test probabilities, which can be applied to rule in the disease (Fig 6). The value of PPV and NPV was 90.6% and 87% in total arteries, 92.8% and 97% in main + lobar arteries and 89% and 89% in segmental arteries, respectively.

Bottom Line: This resulted in a pooled diagnostic odds ratio (DOR) of 191 (95%CI: 75 to 486).This resulted in a pooled diagnostic odds ratio of 76 (95%CI: 23 to 254),751 (95%CI: 57 to 9905) and 189 (95%CI: 21 to 1072), respectively.In the near future, CT could position itself as the key for screening consideration and for surgical and interventional operability.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China.

ABSTRACT
This study aimed to determine the diagnostic accuracy of computed tomography imaging for the diagnosis of chronic thromboembolic pulmonary hypertension (CTEPH). Additionally, the effect of test and study characteristics was explored. Studies published between 1990 and 2015 identified by PubMed, OVID search and citation tracking were examined. Of the 613 citations, 11 articles (n=712) met the inclusion criteria. The patient-based analysis demonstrated a pooled sensitivity of 76% (95% confidence interval [CI]: 69% to 82%), and a pooled specificity of 96% (95%CI: 93% to 98%). This resulted in a pooled diagnostic odds ratio (DOR) of 191 (95%CI: 75 to 486). The vessel-based analyses were divided into 3 levels: total arteries、main+ lobar arteries and segmental arteries. The pooled sensitivity were 88% (95%CI: 87% to 90%)、95% (95%CI: 92% to 97%) and 88% (95%CI: 87% to 90%), respectively, with a pooled specificity of 90% (95%CI: 88% to 91%)、96% (95%CI: 94% to 97%) and 89% (95% CI: 87% to 91%). This resulted in a pooled diagnostic odds ratio of 76 (95%CI: 23 to 254),751 (95%CI: 57 to 9905) and 189 (95%CI: 21 to 1072), respectively. In conclusion, CT is a favorable method to rule in CTEPH and to rule out pulmonary endarterectomy (PEA) patients for proximal branches. Furthermore, dual-energy and 320-slices CT can increase the sensitivity for subsegmental arterials, which are promising imaging techniques for balloon pulmonary angioplasty (BPA) approach. In the near future, CT could position itself as the key for screening consideration and for surgical and interventional operability.

No MeSH data available.


Related in: MedlinePlus