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Dual-energy CT performance in acute pulmonary embolism: a meta-analysis

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Abstract

Objectives

To evaluate the diagnostic performance of dual-energy computed tomography (DECT) with regard to its post-processing techniques, namely linear blending (LB), iodine maps (IM), and virtual monoenergetic (VM) reconstructions, in diagnosing acute pulmonary embolism (PE).

Methods

This meta-analysis was conducted according to PRISMA. A systematic search on MEDLINE and EMBASE was performed in December 2019, looking for articles reporting the diagnostic performance of DECT on a per-patient level. Diagnostic performance meta-analyses were conducted grouping study parts according to DECT post-processing methods. Correlations between radiation or contrast dose and publication year were appraised.

Results

Seventeen studies entered the analysis. Only lobar and segmental acute PE were considered, subsegmental acute PE being excluded from analysis due to data heterogeneity or lack of data. LB alone was assessed in 6 study parts accounting for 348 patients, showing a pooled sensitivity of 0.87 and pooled specificity of 0.93. LB and IM together were assessed in 14 study parts accounting for 1007 patients, with a pooled sensitivity of 0.89 and pooled specificity of 0.90. LB, IM, and VM together were assessed in 2 studies (for a total 144 patients) and showed a pooled sensitivity of 0.90 and pooled specificity of 0.90. The area under the curve for LB alone, and LB together with IM was 0.93 (not available for studies using LB, IM and VM because of paucity of data). Radiation and contrast dose did not decrease with increasing year of publication.

Conclusions

Considering the published performance of single-energy CT in diagnosing acute PE, either dual-energy or single-energy computed tomography can be comparably used for the detection of acute PE.

Key Points

• Dual-energy CT displayed pooled sensitivity and specificity of 0.87 and 0.93 for linear blending alone, 0.89 and 0.90 for linear blending and iodine maps, and 0.90 and 0.90 for linear blending iodine maps, and virtual monoenergetic reconstructions.

• The performance of dual-energy CT for patient management is not superior to that reported in literature for single-energy CT (0.83 sensitivity and 0.96 specificity).

• Dual-energy CT did not yield substantial advantages in the identification of patients with acute pulmonary embolism compared to single-energy techniques.

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Abbreviations

DECT:

Dual-energy computed tomography

DOR:

Diagnostic odds ratio

IM:

Iodine maps

LB:

Linear blending

LR−:

Negative likelihood ratio

LR+:

Positive likelihood ratio

PE:

Pulmonary embolism

SECT:

Single-energy computed tomography

sROC:

Summary receiver-operating characteristics

VM:

Virtual monoenergetic

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. This study was partially supported by funding from the Italian Ministry of Health to IRCCS Policlinico San Donato.

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Authors and Affiliations

  1. Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milano, Lombardia, Italy

    Caterina B. Monti, Moreno Zanardo, Andrea Cozzi, Francesco Secchi & Francesco Sardanelli

  2. Unit of Radiology, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese (MI), Lombardia, Italy

    Simone Schiaffino, Pietro Spagnolo, Francesco Secchi & Francesco Sardanelli

  3. Division of Cardiothoracic Imaging, Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University Hospital, 1364 Clifton Rd NE, Atlanta, GA, 30322, USA

    Carlo N. De Cecco

Authors
  1. Caterina B. Monti
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  2. Moreno Zanardo
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  3. Andrea Cozzi
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  4. Simone Schiaffino
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  7. Carlo N. De Cecco
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Corresponding author

Correspondence to Simone Schiaffino.

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Guarantor

The scientific guarantor of this publication is Francesco Sardanelli.

Conflict of interest

Francesco Sardanelli has received research grants from and is a member of speakers’ bureau and of advisory group for General Electric Healthcare, Bayer Healthcare, and the Bracco group. Carlo N. De Cecco has received institutional research support and/or honorarium as a speaker from Siemens. Simone Schiaffino has received travel support from Bracco Imaging and is a member of the spearkers’ bureau for General Electric Healthcare. The other authors have no conflict of interest to disclose.

The other authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise.

Informed consent

Written informed consent was not required for this study because of the study design (meta-analysis).

Ethical approval

Institutional Review Board approval was not required because of the study design (meta-analysis).

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• Meta-analysis

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Monti, C.B., Zanardo, M., Cozzi, A. et al. Dual-energy CT performance in acute pulmonary embolism: a meta-analysis. Eur Radiol 31, 6248–6258 (2021). https://doi.org/10.1007/s00330-020-07633-8

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  • DOI: https://doi.org/10.1007/s00330-020-07633-8

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