Bellini Davide, Panvini Nicola, Laghi Andrea, Marin Daniele, Patel Bhavik N, Wang Carolyn L, Carbone Iacopo, Mileto Achille
Department of Radiological Sciences, Oncology and Pathology, "Sapienza" University of Rome, I.C.O.T. Hospital, Latina, Italy.
Department of Radiological Sciences, Oncology and Pathology, "Sapienza" University of Rome, Sant'Andrea University Hospital, Rome, Italy.
AJR Am J Roentgenol. 2019 May;212(5):1044-1053. doi: 10.2214/AJR.18.20625. Epub 2019 Mar 5.
The objective of our study was to perform a systematic review and meta-analysis to evaluate the diagnostic accuracy of dual-energy CT (DECT) for renal mass evaluation. In March 2018, we searched MEDLINE, Cochrane Database of Systematic Reviews, Embase, and Web of Science databases. Analytic methods were based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Pooled estimates for sensitivity, specificity, and diagnostic odds ratios were calculated for DECT-based virtual monochromatic imaging (VMI) and iodine quantification techniques as well as for conventional attenuation measurements from renal mass CT protocols. was used to evaluate heterogeneity. The methodologic quality of the included studies and potential bias were assessed using items from the Quality Assessment Tool for Diagnostic Accuracy Studies 2 (QUADAS-2). Of the 1043 articles initially identified, 13 were selected for inclusion (969 patients, 1193 renal masses). Cumulative data of sensitivity, specificity, and summary diagnostic odds ratio for VMI were 87% (95% CI, 80-92%; , 92.0%), 93% (95% CI, 90-96%; , 18.0%), and 183.4 (95% CI, 30.7-1093.4; , 61.6%), respectively. Cumulative data of sensitivity, specificity, and summary diagnostic odds ratio for iodine quantification were 99% (95% CI, 97-100%; , 17.6%), 91% (95% CI, 89-94%; , 84.2%), and 511.5 (95% CI, 217-1201; , 0%). No significant differences in AUCs were found when comparing iodine quantification to conventional attenuation measurements ( = 0.79). DECT yields high accuracy for renal mass evaluation. Determination of iodine content with the iodine quantification technique shows diagnostic accuracy similar to conventional attenuation measurements from renal mass CT protocols. The iodine quantification technique may be used to characterize incidental renal masses when a dedicated renal mass protocol is not available.
我们研究的目的是进行一项系统评价和荟萃分析，以评估双能CT（DECT）对肾肿块评估的诊断准确性。2018年3月，我们检索了MEDLINE、Cochrane系统评价数据库、Embase和Web of Science数据库。分析方法基于系统评价和荟萃分析的首选报告项目（PRISMA）。计算了基于DECT的虚拟单色成像（VMI）和碘定量技术以及肾肿块CT方案中传统衰减测量的敏感性、特异性和诊断比值比的合并估计值。用于评估异质性。使用诊断准确性研究质量评估工具2（QUADAS-2）中的项目评估纳入研究的方法学质量和潜在偏倚。在最初识别的1043篇文章中，13篇被选中纳入（969例患者，1193个肾肿块）。VMI的敏感性、特异性和汇总诊断比值比的累积数据分别为87%（95%CI，80-92%；，92.0%）、93%（95%CI，90-96%；，18.0%）和183.4（95%CI，30.7-1093.4；，61.6%）。碘定量的敏感性、特异性和汇总诊断比值比的累积数据分别为99%（95%CI，97-100%；，17.6%）、91%（95%CI，89-94%；，84.2%）和511.5（95%CI，217-1201；，0%）。将碘定量与传统衰减测量进行比较时，AUCs未发现显著差异（=0.79）。DECT对肾肿块评估具有较高的准确性。用碘定量技术测定碘含量显示出与肾肿块CT方案中的传统衰减测量相似的诊断准确性。当没有专门的肾肿块方案时，碘定量技术可用于对偶然发现的肾肿块进行特征描述。
