Abstract
Objective
To compare the diagnostic accuracy of dual-energy (DE) virtual non-contrast computed tomography (vNCT) to non-contrast CT (NCT) for the diagnosis of adrenal adenomas.
Methods
Search of multiple databases and grey literature was performed. Two reviewers independently applied inclusion criteria and extracted data. Risk of bias was assessed using QUADAS-2. Summary estimates of diagnostic accuracy were generated and sources of heterogeneity were assessed.
Results
Five studies (170 patients; 192 adrenal masses) were included for diagnostic accuracy assessment; all used dual-source dual-energy CT. Pooled sensitivity for adrenal adenoma on vNCT was 54% (95% CI: 47–62%). Pooled sensitivity for NCT was 57% (95% CI: 45–69%). Pooling of specificity was not performed since no false positives were reported. There was a trend for overestimation of HU density on vNCT as compared to NCT which appeared related to contrast timing. Potential sources of bias were seen regarding the index test and reference standard for the included studies. Potential sources of heterogeneity between studies were seen in adenoma prevalence and intravenous contrast timing.
Conclusions
vNCT images generated from dual-energy CT demonstrated comparable sensitivity to NCT for the diagnosis of adenomas; however the included studies are heterogeneous and at high risk for some types of bias.
Key points
• Similar sensitivity of vNCT to NCT for diagnosis of adenoma
• Heterogeneity could be related to vNCT from early (<=60 sec) CECT studies
• Could not pool specificity as there were no false positives
• Small number of heterogeneous studies at high risk of bias
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Guarantor
The scientific guarantor of this publication is Matthew DF McInnes.
Conflict of interest
The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.
Funding
This study has received funding by the University of Ottawa Department of Radiology Research Stipend Program.
Statistics and biometry
One of the authors has significant statistical expertise.
Ethical approval
Institutional review board approval was not required because this study is a systematic review and approval is waived for this study type at our institution.
Methodology
• Retrospective
• Systematic review and meta-analysis
• Performed at one institution
Appendices
Appendix 1. Search strategies
Embase: 44
Medline: 38
Cochrane: 14
Total with duplicates removed, up to date as of October 23, 2015: 61 articles
NIH Clinical Trials Database: 27
WHO Clinical Trials Registry Platform: 4
Total with duplicates removed, up to date as of March 6, 2016: 28 trials
2013-2015 RSNA, 2015 ARRS, and 2013-2015 ECR Scientific Meetings, up to date as of March 6, 2016: 2 abstracts
Cochrane - Date Run: | 23/10/15 13:05:04.121 | |
ID | Search Hits | |
#1 | adrenal:ti,ab,kw (Word variations have been searched) | 4908 |
#2 | MeSH descriptor: [Tomography, Emission-Computed] explode all trees | 2678 |
#3 | (ct or computed tomograph*):ti,ab,kw (Word variations have been searched) | 66064 |
#4 | #2 or #3 | 66711 |
#5 | dual energy:ti,ab,kw | 2568 |
#6 | #4 and #5 | 644 |
#7 | dect:ti,ab,kw | 10 |
#8 | #6 or #7 | 644 |
#9 | #1 and #8 | 14 |
Cochrane Central Register of Controlled Trials : Issue 9 of 12, September 2015 = 14 results
Database: Embase <1974 to 2015 October 22 > Search Strategy:
1 | adrenal.mp. (170288) |
2 | exp computer assisted tomography/(688233) |
3 | (ct or computed tomograph$).tw. (493269) |
4 | 2 or 3 (838139) |
5 | dual energy.tw. (21990) |
6 | 4 and 5 (4187) |
7 | dual energy computer assisted tomography/or dect.tw. (757) |
8 | 6 or 7 (4277) |
9 | 1 and 8 (44) |
Pubmed (October 23, 2015)
(adrenal[Text Word]) AND ((((((dual energy) OR Dual-Energy Scanned Projection[MeSH Terms])) AND (((CT[Title/Abstract]) OR computed tomograph*[Title/Abstract]) OR Tomography, X-Ray Computed[MeSH Terms]))) OR dect[Title/Abstract]) = 38
Clinical trials
Up to date as of March 5, 2016
ClinicalTrials.gov, a service of the U.S. National Institutes of Health
https://www.clinicaltrials.gov/ct2/home
Search: “adrenal AND computed tomography”
27 studies found.
WHO International Clinical Trials Registry Platform
http://apps.who.int/trialsearch/
Search: “adrenal AND computed tomography”
4 trials found.
Scientific abstracts
Up to date as of March 5, 2016. Titles and abstracts highlighted by search criteria below were screened; abstracts potentially meeting inclusion criteria were counted.
RSNA 2015 MEETING- search “dual-energy”
https://rsna2015.rsna.org/program/?PAGE=7
2 abstracts
RSNA 2014 MEETING- search “dual-energy”
http://rsna2014.rsna.org/program/?PAGE=8
0 abstracts
RSNA 2013 MEETING- search “dual-energy”
http://rsna2013.rsna.org/program/?PAGE=6
0 abstracts
ARRS 2015 MEETING- search “dual-energy”
0 abstracts
ECR 2015 MEETING- https://www.myesr.org/cms/website.php?id=/en/ecr_2015/ecr_2015_boa.htm
Search “Adrenal”-
0 abstracts
ECR 2014 MEETING-
https://www.myesr.org/cms/website.php?id=/en/ecr_2014/ecr_2014_book_of_abstracts.htm
Search “Adrenal”
0 abstracts
ECR 2013 MEETING-
https://www.myesr.org/cms/website.php?id=/30047/en/ecr_2013/book_of_abstracts.htm
Search “Adrenal”
0 abstracts
Appendix 2
Appendix 3
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Connolly, M.J., McInnes, M.D.F., El-Khodary, M. et al. Diagnostic accuracy of virtual non-contrast enhanced dual-energy CT for diagnosis of adrenal adenoma: A systematic review and meta-analysis. Eur Radiol 27, 4324–4335 (2017). https://doi.org/10.1007/s00330-017-4785-0
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DOI: https://doi.org/10.1007/s00330-017-4785-0