Sun Lixin, Yao Jian, Hao Pan, Yang Yuanyuan, Liu Zhimou, Peng Ruchen
Department of Nuclear Medicine, Beijing Luhe Hospital, Capital Medical University, No 82 Xinhua South Road, Tongzhou District, Beijing 101149, China.
Department of Radiology, Beijing Luhe Hospital, Capital Medical University, No 82 Xinhua South Road, Tongzhou District, Beijing 101149, China.
Diagnostics (Basel). 2021 Apr 7;11(4):664. doi: 10.3390/diagnostics11040664.
We sought to systematically evaluate diagnostic performance of four-dimensional computed tomography (4D-CT) in the localization of hyperfunctioning parathyroid glands (HPGs) in patients with primary hyperparathyroidism (pHPT). We calculated the pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratios (DOR) of 4D-CT on a per-lesion level, as well as pooled sensitivity and positive predictive value (PPV) on a per-patient level with 95% confidence intervals (CIs). Additionally, we plotted summary receiver operating characteristic (SROC) curves and evaluated the areas under the curves (AUC). A total of 16 studies were included in the analysis. Their pooled sensitivity, specificity, PLR, NLR, and DOR of 4D-CT on per-lesion level were 75% (95%CI: 66-82%), 85% (95%CI: 50-97%), 4.9 (95%CI: 1.1-21.3), 0.30 (95%CI: 0.19-0.45), and 17 (95%CI: 3-100), respectively, with an AUC of 81% (95%CI: 77-84%). We also observed heterogeneity in sensitivity (I = 79%) and specificity (I = 94.7%), and obtained a pooled sensitivity of 81% (95%CI: 70-90%) with heterogeneity of 81.9% ( < 0.001) and PPV of 91% (95%CI: 82-98%) with heterogeneity of 80.8% ( < 0.001), based on a per-patient level. Overall, 4D-CT showed moderate sensitivity and specificity for preoperative localization of HPG(s) in patients with pHPT. The diagnostic performance may improve with 4D-CT's promotion to first-line use on a lesion-based level, further research is needed to confirm the results.
我们试图系统评估四维计算机断层扫描（4D-CT）在原发性甲状旁腺功能亢进症（pHPT）患者中定位功能亢进甲状旁腺（HPG）的诊断性能。我们计算了4D-CT在每个病灶水平上的合并敏感性、特异性、阳性似然比（PLR）、阴性似然比（NLR）和诊断比值比（DOR），以及在每位患者水平上的合并敏感性和阳性预测值（PPV），并给出95%置信区间（CI）。此外，我们绘制了汇总的受试者工作特征（SROC）曲线并评估曲线下面积（AUC）。分析共纳入16项研究。4D-CT在每个病灶水平上的合并敏感性、特异性、PLR、NLR和DOR分别为75%（95%CI：66-82%）、85%（95%CI：50-97%）、4.9（95%CI：1.1-21.3）、0.30（95%CI：0.19-0.45）和17（95%CI：3-100），AUC为81%（95%CI：77-84%）。我们还观察到敏感性（I² = 79%）和特异性（I² = 94.7%）存在异质性，在每位患者水平上，获得的合并敏感性为81%（95%CI：70-90%），异质性为81.9%（P < 0.001），PPV为91%（95%CI：82-98%），异质性为80.8%（P < 0.001）。总体而言，4D-CT对pHPT患者术前定位HPG显示出中等的敏感性和特异性。随着4D-CT在病灶层面被推广为一线检查手段，其诊断性能可能会提高，需要进一步研究来证实结果。
