Ferrone Nicholas G, Sanmartin Maria X, O'Hara Joseph, Jimenez Jean, Ferrone Sophia R, Lodato Zachary, Lacher Gregory, Bandi Sanjana, Convey Alicia, Bastani Mehrad, Lee Un Jung, Morales Vialet Jaclyn, White Timothy, Wang Jason J, Katz Jeffrey M, Sanelli Pina C
Northwell, New Hyde Park, New York; Institute of Health System Science, The Feinstein Institutes for Medical Research, Manhasset, New York.
Northwell, New Hyde Park, New York; Department of Radiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York.
J Am Coll Radiol. 2024 Dec;21(12):1841-1850. doi: 10.1016/j.jacr.2024.07.026. Epub 2024 Aug 13.
Our purpose was to synthesize evidence in the literature to determine the diagnostic accuracy of cone-beam CT (CBCT) for the detection of intracranial hemorrhage (ICH) and hemorrhage types, including intraparenchymal hemorrhage (IPH), subarachnoid hemorrhage (SAH), and intraventricular hemorrhage (IVH).
We performed a meta-analysis following the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. Our protocol was registered with International Prospective Register of Systematic Reviews (PROSPERO-CRD42021261915). Systematic searches were last performed on April 30, 2024, in EMBASE, PubMed, Web-of-Science, Scopus, and Cumulative Index to Nursing and Allied Health Literature databases. Inclusion criteria were (1) studies reporting diagnostic metrics of CBCT for ICH and (2) studies using a reference standard to determine ICH. Exclusion criteria were (1) case reports, abstracts, reviews and (2) studies without patient-level data. Pooled estimates and 95% confidence intervals (CIs) were calculated for diagnostic odds ratios (DORs), sensitivity, and specificity using random-effects and common-effects models. Mixed methods appraisal tool was used to evaluate risk of bias.
Seven studies were included in the meta-analysis yielding 466 patients. Mean or median age ranged from 54 to 75 years. Female patients represented 51.4% (222 of 432) in reported studies. Multidetector CT was the reference standard in all studies. DOR, pooled sensitivity, and pooled specificity for ICH were 5.28 (95% CI: 4.11-6.46), 0.88 (95% CI: 0.79-0.97), and 0.99 (95% CI: 0.98-1.0). Pooled sensitivity for IPH, SAH, and IVH was 0.98 (95% CI: 0.95-1.0), 0.82 (95% CI: 0.57-1.0), and 0.78 (95% CI: 0.55-1.0). Pooled specificity for IPH, SAH, and IVH was 0.99 (95% CI: 0.98-1.0), 0.99 (95% CI: 0.97-1.0), and 1.0 (95% CI: 0.98-1.0).
CBCT had moderate DOR and high pooled specificity for ICH and hemorrhage types. However, pooled sensitivity varied by hemorrhage type, with the highest sensitivity for IPH, followed by SAH and IVH.
我们的目的是综合文献中的证据，以确定锥形束CT（CBCT）检测颅内出血（ICH）及出血类型的诊断准确性，这些出血类型包括脑实质内出血（IPH）、蛛网膜下腔出血（SAH）和脑室内出血（IVH）。
我们按照系统评价和Meta分析的首选报告项目指南进行了一项Meta分析。我们的方案已在国际前瞻性系统评价注册库（PROSPERO-CRD42021261915）中注册。系统检索于2024年4月30日最后一次在EMBASE、PubMed、科学网、Scopus以及护理与联合健康文献累积索引数据库中进行。纳入标准为：（1）报告CBCT对ICH诊断指标的研究；（2）使用参考标准确定ICH的研究。排除标准为：（1）病例报告、摘要、综述；（2）无患者层面数据的研究。使用随机效应模型和共同效应模型计算诊断比值比（DOR）、敏感性和特异性的合并估计值及95%置信区间（CI）。使用混合方法评估工具评估偏倚风险。
Meta分析纳入了7项研究，共466例患者。平均或中位数年龄在54至75岁之间。在报告的研究中，女性患者占51.4%（432例中的222例）。所有研究中多排CT均为参考标准。ICH的DOR、合并敏感性和合并特异性分别为5.28（95%CI：4.11 - 6.46）、0.88（95%CI：0.79 - 0.97）和0.99（95%CI：0.98 - 1.0）。IPH、SAH和IVH的合并敏感性分别为0.98（95%CI：0.95 - 1.0）、0.82（95%CI：0.57 - 1.0）和0.78（95%CI：0.55 - 1.0）。IPH、SAH和IVH的合并特异性分别为0.99（95%CI：0.98 - 1.0）、0.99（95%CI：0.97 - 1.0）和1.0（95%CI：0.98 - 1.0）。
CBCT对ICH及出血类型具有中等的DOR和较高的合并特异性。然而，合并敏感性因出血类型而异，IPH的敏感性最高，其次是SAH和IVH。
