低剂量计算机断层扫描（CT）在儿童先天性心脏病诊断中的应用：一项荟萃分析。

Low-dose Computed Tomography (CT) for the Diagnosis of Congenital Heart Disease in Children: A Meta-analysis.

机构信息

Department of Radiology, Chongqing Medical University, Children's Hospital, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing International Science and Technology Cooperation Center for Child Development and Disorders and Key Laboratory of Pediatrics in Chongqing, Chongqing 400014, China.

出版信息

Curr Med Imaging. 2020;16(9):1085-1094. doi: 10.2174/1573405616666200107110611.

DOI:10.2174/1573405616666200107110611

PMID:33135610

Abstract

BACKGROUND

Low dose CT has become a promising examination method for the diagnosis of Congenital heart disease (CHD) in children because it has a low radiation dose, but it has not been widely accepted as an alternative to standard-dose CT in clinical applications due to concerns about image quality. Therefore, we suggest that the diagnostic accuracy, image quality, and radiation dose of low-dose CT for CHD in children should be fully explored through a metaanalysis of existing studies.

METHODS

A comprehensive search was performed to identify relevant English and Chinese articles (from inception to May 2019). All selected studies concerned the diagnosis of CHD in children using low-dose CT. The accuracy of low-dose CT was determined by calculating pooled estimates of sensitivity, specificity, diagnostic odds ratio, and likelihood ratio. Pooling was conducted using a bivariate generalized linear mixed model. Forest plots and summary receiver operating characteristic (SROC) curves were generated.

RESULTS

Ten studies, accounting for 577 patients, met the eligibility criteria. The pooled sensitivity and specificity were 0.95 (95% confidence interval (CI) 0.92-0.97) and 1.00 (95% CI 1.00- 1.00), respectively. The pooled diagnostic odds ratio, positive likelihood ratio, and negative likelihood ratio of low-dose CT were 12705.53 (95% CI 5065.00-31871.73), 671.29 (95% CI 264.77- 1701.97), and 0.05 (95% CI 0.03-0.08), respectively. Additionally, the area under the SROC curve was 1.00 (95% CI 0.99-1.00), suggesting that low-dose CT is an excellent diagnostic tool for CHD in children.

CONCLUSION

Low-dose CT, especially with a prospective ECG-triggering mode, provides excellent imaging quality and high diagnostic accuracy for CHD in children.

摘要

背景

低剂量 CT 因其辐射剂量低，已成为儿童先天性心脏病（CHD）诊断的一种很有前途的检查方法，但由于对图像质量的担忧，它尚未在临床应用中被广泛接受作为标准剂量 CT 的替代方法。因此，我们建议通过对现有研究进行荟萃分析，充分探讨低剂量 CT 对儿童 CHD 的诊断准确性、图像质量和辐射剂量。

方法

全面检索了相关的英文和中文文献（从建库到 2019 年 5 月）。所有入选的研究均涉及使用低剂量 CT 诊断儿童 CHD。通过计算敏感性、特异性、诊断优势比和似然比的汇总估计值来确定低剂量 CT 的准确性。使用双变量广义线性混合模型进行汇总。生成森林图和汇总受试者工作特征（SROC）曲线。

结果

符合纳入标准的研究有 10 项，共 577 例患者。汇总的敏感性和特异性分别为 0.95（95%置信区间（CI）0.92-0.97）和 1.00（95%CI 1.00-1.00）。低剂量 CT 的汇总诊断优势比、阳性似然比和阴性似然比分别为 12705.53（95%CI 5065.00-31871.73）、671.29（95%CI 264.77-1701.97）和 0.05（95%CI 0.03-0.08）。此外，SROC 曲线下面积为 1.00（95%CI 0.99-1.00），表明低剂量 CT 是一种优秀的儿童 CHD 诊断工具。