Abstract：
OBJECTIVE: Our purpose was to synthesize evidence in the literature to determine the diagnostic accuracy of Cone-Beam CT (CBCT) for detection of intracranial hemorrhage (ICH) and hemorrhage types, including intraparenchymal (IPH), subarachnoid (SAH), and intraventricular (IVH).
METHODS: We performed a meta-analysis following the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) 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 CINAHL databases. Inclusion criteria were: (1) Studies reporting diagnostic metrics of CBCT for ICH; (2) Studies using a reference standard to determine ICH. Exclusion criteria were: (1) Case reports, abstracts, reviews; (2) Studies without patient-level data. Pooled-estimates and 95% confidence intervals (CI) were calculated for diagnostic Odds ratio (DOR), 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/median age ranged from 54-75 years. Females represented 51.4% (222/432) 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 were 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 were 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).
CONCLUSIONS: 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.
METHODS: We performed a meta-analysis following the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) 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 CINAHL databases. Inclusion criteria were: (1) Studies reporting diagnostic metrics of CBCT for ICH; (2) Studies using a reference standard to determine ICH. Exclusion criteria were: (1) Case reports, abstracts, reviews; (2) Studies without patient-level data. Pooled-estimates and 95% confidence intervals (CI) were calculated for diagnostic Odds ratio (DOR), 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/median age ranged from 54-75 years. Females represented 51.4% (222/432) 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 were 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 were 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).
CONCLUSIONS: 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.
摘要：
目的：我们的目的是综合文献中的证据，以确定锥束CT（CBCT）用于检测颅内出血（ICH）和出血类型的诊断准确性，包括实质内（IPH），蛛网膜下腔(SAH),和心室内（IVH）。
方法：我们遵循系统评价和荟萃分析（PRISMA）指南的首选报告项目进行了荟萃分析。我们的方案已在国际前瞻性系统审查登记册（PROSPERO-CRD42021261915）注册。系统搜索最后一次在2024年4月30日在EMBASE进行，PubMed,Web-of-Science,Scopus,和CINAHL数据库。纳入标准为:(1)报告ICH的CBCT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）没有患者水平数据的研究。汇总估计和95%置信区间(CI)计算诊断赔率比(DOR)，灵敏度,以及使用随机效应和共同效应模型的特异性。使用混合方法评估工具评估偏倚风险。
结果：7项研究纳入荟萃分析，共466例患者。平均年龄/中位数为54-75岁。在报告的研究中，女性占51.4%(222/432)。多探测器CT是所有研究的参考标准。DOR,汇集敏感性，ICH的合并特异性为5.28（95CI：4.11-6.46），0.88（95CI：0.79-0.97），和0.99（95CI：0.98-1.0）。IPH的汇集灵敏度,SAH,IVH为0.98（95CI：0.95-1.0），0.82（95CI：0.57-1.0），和0.78（95CI：0.55-1.0）。IPH的集合特异性，SAH,IVH为0.99（95CI：0.98-1.0），0.99（95CI：0.97-1.0），和1.0（95CI：0.98-1.0）。
结论：CBCT对ICH和出血类型具有中等的DOR和高的合并特异性。然而,合并敏感性因出血类型而异，具有最高的IPH灵敏度，其次是SAH和IVH。
方法：我们遵循系统评价和荟萃分析（PRISMA）指南的首选报告项目进行了荟萃分析。我们的方案已在国际前瞻性系统审查登记册（PROSPERO-CRD42021261915）注册。系统搜索最后一次在2024年4月30日在EMBASE进行，PubMed,Web-of-Science,Scopus,和CINAHL数据库。纳入标准为:(1)报告ICH的CBCT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）没有患者水平数据的研究。汇总估计和95%置信区间(CI)计算诊断赔率比(DOR)，灵敏度,以及使用随机效应和共同效应模型的特异性。使用混合方法评估工具评估偏倚风险。
结果：7项研究纳入荟萃分析，共466例患者。平均年龄/中位数为54-75岁。在报告的研究中，女性占51.4%(222/432)。多探测器CT是所有研究的参考标准。DOR,汇集敏感性，ICH的合并特异性为5.28（95CI：4.11-6.46），0.88（95CI：0.79-0.97），和0.99（95CI：0.98-1.0）。IPH的汇集灵敏度,SAH,IVH为0.98（95CI：0.95-1.0），0.82（95CI：0.57-1.0），和0.78（95CI：0.55-1.0）。IPH的集合特异性，SAH,IVH为0.99（95CI：0.98-1.0），0.99（95CI：0.97-1.0），和1.0（95CI：0.98-1.0）。
结论：CBCT对ICH和出血类型具有中等的DOR和高的合并特异性。然而,合并敏感性因出血类型而异，具有最高的IPH灵敏度，其次是SAH和IVH。
