What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Chronic Thromboembolic Pulmonary Hypertension (CTEPH) (n=712). Intervention: Computed Tomography (CT) vs. Digital Subtraction Angiography (DSA) and/or V/Q scanning. Primary outcome: Diagnostic accuracy (patient-based sensitivity and specificity) (DOR 191, 95% CI 75 to 486).

April 29, 2015Open Access

Diagnostic Accuracy of Computed Tomography for Chronic Thromboembolic Pulmonary Hypertension: A Systematic Review and Meta-Analysis

Key Result

Computed tomography demonstrated a pooled sensitivity of 76% and a pooled specificity of 96% for diagnosing chronic thromboembolic pulmonary hypertension, yielding a diagnostic odds ratio of 191.

Study Design

Type

Meta-Analysis (n=712)

Structured PICO

Does computed tomography accurately diagnose chronic thromboembolic pulmonary hypertension in patients with suspected or confirmed CTEPH compared to DSA or V/Q scanning?

Population

712 patients referred for suspected or confirmed chronic thromboembolic pulmonary hypertension (CTEPH) across 11 studies.

Intervention

Computed tomography (CT) imaging (including multidetector-row CT, dual-energy CT, and 320-slices CT).

Comparator

Digital subtraction angiography (DSA) and/or ventilation/perfusion (V/Q) scanning as reference standard.

Outcome

Diagnostic accuracy (sensitivity, specificity, and diagnostic odds ratio) of CT for CTEPH on patient-based and vessel-based analyses.surrogate

CT is a highly specific and moderately sensitive non-invasive imaging modality for diagnosing CTEPH, particularly useful for ruling in the disease and assessing proximal branches.

Main Result

Effect estimate: DOR 191 (95% CI 75 to 486)

Absolute Event Rate: 76% vs 96%

Limitations

The number of included studies was insufficient, which might reduce statistical power.
Combined results from trials with different CT techniques may lead to bias.
Including patients referred for suspected or confirmed CTEPH may lead to bias.
The use of different reference standards (DSA or V/Q scanning) influences the reliability of the pooled data.
Some potential factors might be missed in subgroup analyses, such as the contrast agent and prevalence.
Diagnostic value of CTEPH in subsegmental arterials was not evaluated due to lack of data.

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.

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