1 Clinical Epidemiology Program, Ottawa Hospital Research Institute, School of Epidemiology, Public Health and Preventive Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
2 Department of Radiology, University of Ottawa, Ottawa Hospital Civic Campus, 1053 Carling Ave, Rm c159, Ottawa, ON K1Y 4E9, Canada.
AJR Am J Roentgenol. 2019 Apr;212(4):W100-W105. doi: 10.2214/AJR.18.20527. Epub 2019 Feb 4.
The purpose of this study is to determine the diagnostic accuracy of dual-energy CT (DECT) using quantitative iodine concentration in patients with renal masses using histopathologic analysis or follow-up imaging as the reference standard. The secondary objective is to compare the accuracy of DECT (using iodine concentration) to that of conventional CT (using Hounsfield unit measurements).
We searched the MEDLINE, Embase, and Cochrane Central Register of Controlled Trials databases for studies evaluating the accuracy of DECT for renal mass characterization (1947-2018). To be included, studies had to evaluate quantitative iodine concentrations in human patients with indeterminate renal masses. Risk of bias and applicability were assessed using quality assessment of diagnostic accuracy studies-2. A bivariate random-effects model was used to determine pooled sensitivity and specificity. Variability was assessed by subgroup analyses (DECT technique and risk of bias) and metaregression using test type and threshold applied as covariates.
Of 201 studies identified, five were included (367 patients). Pooled sensitivity and specificity for DECT were 96.6% (95% CI, 85.9-99.3%) and 95.1% (95% CI, 90.7-97.5%), respectively. Metaregression evaluating the influence of the test type (DECT vs conventional CT) did not identify differences in accuracy (p = 0.06). No differences in accuracy based on risk of bias or DECT technique were identified. Limitations include the small number of studies, most of which were at risk of bias.
DECT with iodine quantification shows sensitivity and specificity greater than 95% for evaluation of renal masses and may be an alternative to conventional CT for assessment of renal masses. Larger scale trials are needed to corroborate our findings.
本研究旨在通过组织病理学分析或随访影像学作为参考标准，确定双能 CT（DECT）使用定量碘浓度对肾肿块患者的诊断准确性。次要目的是比较 DECT（使用碘浓度）与常规 CT（使用 Hounsfield 单位测量值）的准确性。
我们检索了 MEDLINE、Embase 和 Cochrane 对照试验中心注册数据库，以评估 DECT 对肾肿块特征评估的准确性（1947 年至 2018 年）的研究。纳入研究必须评估不确定肾肿块的人类患者的定量碘浓度。使用诊断准确性研究质量评估-2 评估偏倚风险和适用性。使用双变量随机效应模型确定汇总敏感性和特异性。通过亚组分析（DECT 技术和偏倚风险）和使用测试类型和应用的阈值作为协变量的元回归评估变异性。
在 201 项研究中，有 5 项研究（367 名患者）被纳入。DECT 的汇总敏感性和特异性分别为 96.6%（95%CI，85.9-99.3%）和 95.1%（95%CI，90.7-97.5%）。评估测试类型（DECT 与常规 CT）对准确性影响的元回归未发现准确性差异（p=0.06）。基于偏倚或 DECT 技术的准确性没有差异。局限性包括研究数量较少，其中大多数存在偏倚风险。
DECT 定量碘显示出对评估肾肿块的敏感性和特异性大于 95%，可能是评估肾肿块的常规 CT 的替代方法。需要更大规模的试验来证实我们的发现。
