Diagnostic performance of dual-energy computed tomography (DECT) quantitative parameters for detecting metastatic cervical lymph nodes in patients with papillary thyroid cancer: A systematic review and meta-analysis

Purpose

This study systematically evaluated the diagnostic performance of dual-energy computed tomography (DECT) quantitative parameters in detecting cervical lymph node metastasis in patients with papillary thyroid cancer (PTC).

Method

We searched PubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure, and Wanfang Data databases for relevant original studies from database inception to March 2024. The quality of the included studies was evaluated using the QUADAS-2 tool. A bivariate random-effects model was used to calculate the pooled sensitivity and specificity of DECT. The threshold effect was determined by calculating Spearman correlation coefficients, meta-regression and subgroup analysis were performed to evaluate the sources of variability. Publication bias was assessed using the asymmetry of Deek’s funnel plot.

Results

Thirteen studies involving 951 patients (2,782 lymph nodes) were included in this meta-analysis. We analyzed four quantitative parameters of DECT, among which the normalized iodine concentration (NIC) in the arterial phase had the highest area under the receiver operating characteristic curve (AUC). The combined sensitivity, specificity, and AUC were 83 % (95 % confidence interval [CI]: 76 % – 89 %), 90 % (95 % CI: 82 % – 95 %), and 0.92 (95 % CI: 0.90 – 0.94), respectively. The Spearman correlation coefficient was − 0.244 (p = 0.4). Meta-regression and subgroup analysis revealed that use of blinding, mean patients’ age, female proportion, presence of Hashimoto’s thyroiditis, number of lymph nodes included in the study, and slice thickness were sources of heterogeneity for the NIC in the arterial phase. No significant publication bias was observed among the studies.

Conclusions

DECT, a noninvasive technique, can be used to distinguish metastatic from nonmetastatic cervical lymph nodes in patients with PTC by measuring quantitative lymph node parameters.