Diagnostic Accuracy of Dual-Energy CT in Detection of Acute Pulmonary Embolism: A Systematic Review and Meta-Analysis

Abstract

Purpose: In this systematic review and meta-analysis, we aimed to investigate the accuracy of dual-energy computed tomography (DECT) in the detection of acute pulmonary embolism (PE). Methods: We searched Medline (via PubMed), EBSCO, Web of Science, Scopus, and the Cochrane Library for relevant published studies. We selected studies assessing the accuracy of DECT in the detection of PE. Quality assessment of bias and applicability was conducted using the Quality of Diagnostic Accuracy Studies-2 tool. Meta-analysis was performed to calculate mean estimates of sensitivity, specificity, positive likelihood ratio (PLR), and negative likelihood ratio (NLR). The summary receiver operating characteristic (sROC) curve was drawn to get the Cochran Q-index and the area under the curve (AUC). Results: Seven studies were included in our systematic review. Of the 182 patients included, 108 patients had PEs. The pooled analysis showed an overall sensitivity and specificity of 88.9% (95% confidence interval [CI]: 81.4%-94.1%) and 94.6% (95% CI: 86.7%-98.5%), respectively. The pooled PLR was 8.186 (95% CI: 3.726-17.986), while the pooled NLR was 0.159 (95% CI: 0.093-0.270). Cochran-Q was 0.8712, and AUC was 0.935 in the sROC curve. Conclusion: Dual-energy computed tomography shows high sensitivity, specificity, and diagnostic accuracy in the detection of acute PE. The high PLR highlights the high clinical importance of DECT as a prevalence-independent, rule-in test. Studies with a larger sample size with standardized reference tests are still needed to increase the statistical power of the study and support these findings.

Acute Pulmonary Embolism: Prognostic Role of Computed Tomography Pulmonary Angiography (CTPA)

“…According to recent studies, the use of new CT technologies such as dual-energy computed tomography (DECT) would provide additional information compared to singleenergy CT with lower contrast doses and radiation [46][47][48]. Using monoenergetic image reconstructions, the attenuation of the vessel and the contrast-noise ratio can be improved while using a small amount of contrast agent.…”

CARJ 2021: Year in Review

“…In 2020, the CARJ published a systematic review and meta-analysis on the diagnostic accuracy of DECT for the detection of pulmonary embolism (PE). 7 The authors included 7 studies in their meta-analysis after rigorous interrogation of the literature. In a combined 108 patients with PE, pooled analysis demonstrated overall excellent performance of DECT for detection of pulmonary embolism (PE).…”

Use of dual-energy computed tomography to detect mycoplasma-related pulmonary embolism and splenic infarction

“…This technique showed high diagnostic accuracy, which greatly aids in the assessment of pulmonary parenchymal perfusion defect and the detection of small, peripheral clots. 3 We believe that lung perfusion imaging using DECT can provide valuable functional information on the pulmonary parenchyma of patients with pulmonary embolisms.…”