Diagnostic Accuracy of Cone-Beam CT for Acute Intracranial Hemorrhage: A Systematic Review and Meta-Analysis

IF 4 3区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Journal of the American College of Radiology Pub Date : 2024-12-01 DOI:10.1016/j.jacr.2024.07.026

Nicholas G. Ferrone , Maria X. Sanmartin PhD , Joseph O’Hara , Jean Jimenez , Sophia R. Ferrone , Zachary Lodato DO , Gregory Lacher MD , Sanjana Bandi MD , Alicia Convey , Mehrad Bastani PhD , Un Jung Lee PhD , Jaclyn Morales Vialet , Timothy White MD , Jason J. Wang PhD , Jeffrey M. Katz MD , Pina C. Sanelli MD, MPH

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Abstract

Objective

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).

Methods

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.

Results

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).

Discussion

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.

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锥形束 CT 对急性颅内出血的诊断准确性：系统回顾与元分析》。

目的：我们的目的是综合文献证据，确定锥形束 CT（CBCT）在检测颅内出血（ICH）和出血类型（包括实质内出血（IPH）、蛛网膜下腔出血（SAH）和脑室内出血（IVH））方面的诊断准确性：我们按照《系统综述和荟萃分析首选报告项目》（Preferred Reporting Items for Systematic Review and Meta-Analyses，PRISMA）指南进行了荟萃分析。我们的方案已在国际系统综述前瞻性注册中心（PROSPERO-CRD42021261915）注册。我们于 2024 年 4 月 30 日在 EMBASE、PubMed、Web-of-Science、Scopus 和 CINAHL 数据库中进行了最后一次系统检索。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。使用随机效应和共同效应模型计算诊断率（DOR）、灵敏度和特异性的汇总估计值和 95% 置信区间（CI）。使用混合方法评估工具评估偏倚风险：荟萃分析纳入了七项研究，共有 466 名患者。平均/中位年龄为 54-75 岁。在报告的研究中，女性占 51.4%（222/432）。所有研究均以多载体 CT 为参考标准。ICH的DOR、集合敏感性和集合特异性分别为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的集合敏感性分别为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的集合特异性分别为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）：讨论：CBCT 对 ICH 和出血类型具有中等程度的 DOR 和较高的集合特异性。然而，不同出血类型的集合敏感性各不相同，IPH的敏感性最高，其次是SAH和IVH。

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来源期刊

Journal of the American College of Radiology RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING-

CiteScore

6.30

自引率

8.90%

发文量

312

审稿时长

34 days

期刊介绍： The official journal of the American College of Radiology, JACR informs its readers of timely, pertinent, and important topics affecting the practice of diagnostic radiologists, interventional radiologists, medical physicists, and radiation oncologists. In so doing, JACR improves their practices and helps optimize their role in the health care system. By providing a forum for informative, well-written articles on health policy, clinical practice, practice management, data science, and education, JACR engages readers in a dialogue that ultimately benefits patient care.

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