疑似肺栓塞患者 SPECT 成像的诊断准确性：系统评价和网络荟萃分析。
The Diagnostic Accuracy of SPECT Imaging in Patients With Suspected Pulmonary Embolism: Systematic Review and Network Meta-analysis.
机构信息
From the Department of Nuclear Medicine, CHA Bundang Medical Center, CHA University, Pocheon.
Department of Nuclear Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju.
出版信息
Clin Nucl Med. 2024 Jul 1;49(7):637-643. doi: 10.1097/RLU.0000000000005167.
BACKGROUND
This meta-analysis and systematic review assessed the diagnostic accuracy of lung SPECT compared with lung planar imaging in patients with suspected acute pulmonary embolism (PE) or chronic thromboembolic pulmonary hypertension.
PATIENTS AND METHODS
A search of Medline, Embase, and Cochrane databases identified suitable articles published before October 2023. Meta-analyses were performed to determine the diagnostic accuracy of SPECT imaging modalities, including perfusion (Q) SPECT, ventilation (V)/Q SPECT, Q SPECT/CT, and V/Q SPECT/CT. Network meta-analyses were performed to compare the diagnostic accuracy of SPECT and planar imaging in paired-design studies.
RESULTS
Twenty-four articles (total n = 6576) were included in the analysis. For suspected acute PE, the respective sensitivity and specificity of SPECT imaging modalities were as follows: Q SPECT, 0.93 (95% confidence interval [CI], 0.87-0.99; I2 = 49%) and 0.72 (95% CI, 0.54-0.95; I2 = 94%); V/Q SPECT, 0.96 (95% CI, 0.94-0.98; I2 = 51%) and 0.95 (95% CI, 0.92-0.98; I2 = 80%); Q SPECT/CT, 0.93 (95% CI, 0.87-0.98; I2 = 66%) and 0.82 (95% CI, 0.70-0.96; I2 = 87%); and V/Q SPECT/CT, 0.97 (95% CI, 0.93-1.00; I2 = 7%) and 0.98 (95% CI, 0.97-1.00; I2 = 31%). The relative sensitivity and specificity of SPECT compared with planar imaging were 1.17 (95% CI, 1.06-1.30; P < 0.001) and 1.14 (95% CI, 1.00-1.29; P = 0.05), respectively. For suspected chronic thromboembolic pulmonary hypertension, the pooled sensitivity and specificity of SPECT imaging were 0.97 (95% CI, 0.95-1.00; I2 = 0%) and 0.91 (95% CI, 0.87-0.94; I2 = 0%), respectively.
CONCLUSIONS
SPECT exhibited superior diagnostic performance for PE. V/Q SPECT/CT was the most accurate modality.
背景
本荟萃分析和系统评价评估了肺部单光子发射计算机断层扫描（SPECT）与肺部平面成像在疑似急性肺栓塞（PE）或慢性血栓栓塞性肺动脉高压患者中的诊断准确性。
患者和方法
在 2023 年 10 月之前，对 Medline、Embase 和 Cochrane 数据库进行了检索，以确定合适的已发表文章。进行了荟萃分析，以确定 SPECT 成像方式的诊断准确性，包括灌注（Q）SPECT、通气（V）/Q SPECT、Q SPECT/CT 和 V/Q SPECT/CT。进行了网络荟萃分析，以比较配对设计研究中 SPECT 和平面成像的诊断准确性。
结果
共纳入 24 篇文章（总计 n = 6576）进行分析。对于疑似急性 PE，SPECT 成像方式的灵敏度和特异性分别为：Q SPECT，0.93（95%置信区间 [CI]，0.87-0.99；I2 = 49%）和 0.72（95% CI，0.54-0.95；I2 = 94%）；V/Q SPECT，0.96（95% CI，0.94-0.98；I2 = 51%）和 0.95（95% CI，0.92-0.98；I2 = 80%）；Q SPECT/CT，0.93（95% CI，0.87-0.98；I2 = 66%）和 0.82（95% CI，0.70-0.96；I2 = 87%）；V/Q SPECT/CT，0.97（95% CI，0.93-1.00；I2 = 7%）和 0.98（95% CI，0.97-1.00；I2 = 31%）。SPECT 与平面成像相比的相对灵敏度和特异性分别为 1.17（95% CI，1.06-1.30；P < 0.001）和 1.14（95% CI，1.00-1.29；P = 0.05）。对于疑似慢性血栓栓塞性肺动脉高压，SPECT 成像的汇总灵敏度和特异性分别为 0.97（95% CI，0.95-1.00；I2 = 0%）和 0.91（95% CI，0.87-0.94；I2 = 0%）。
结论
SPECT 在 PE 诊断中表现出更高的诊断性能。V/Q SPECT/CT 是最准确的模式。
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