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。
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.