Diagnostic accuracy of imaging modalities for adults with acute pulmonary embolism: systematic review and meta-analysis

William Ransome, Janine Dizon, Shayne Chau, Katherine Guerrero

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Abstract

Objectives: This systematic review aimed to evaluate the current evidence regarding diagnostic test accuracy of imaging modalities for adults with acute pulmonary embolism. Methods: A literature search of PubMed, Embase, Trove and MedNar databases (2012–2020; English language) was performed. Eligible studies were pooled using the random or fixed-effects model, with the remainder summarised using descriptive synthesis. Between-study heterogeneity was assessed using the Higgins I2 test. Results: 16 studies, involving 1934 participants, were enrolled with 10 studies (six ultrasound, four MRI) being pooled using the fixed effects model. Sensitivity, specificity, negative likelihood ratio, positive likelihood ratio and diagnostic odds ratio were calculated. Thoracic ultrasound exhibited 0.72 (95% CI, 0.66–0.79), 0.95 (95% CI, 0.92–0.97), 0.22 (95% CI, 0.11–0.46), 13.3 (95% CI, 8.31–21.3) and 54.0 (95% CI, 21.3–137.0). Focussed cardiac ultrasound showed 0.57 (95% CI, 0.50–0.65), 0.84 (95% CI, 0.80–0.88), 0.22 (95% CI, 0.03–1.60), 3.89 (95% CI, 2.10–7.20), 17.56 (95% CI, 3.59–85.9). Pulmonary MRI demonstrated 0.90 (95% CI, 0.81–0.96), 0.99 (95% CI, 0.93–1.00), 0.12 (95% CI, 0.06–0.22), 38.5 (95% CI, 7.90–187.10), 285.1 (95% CI, 45.10–1783.70). Magnetic resonance pulmonary angiography presented 0.93 (95% CI, 0.84–0.98), 0.88 (95% CI, 0.64–0.99), 0.95 (95% CI, 0.03–0.35), 6.48 (95% CI, 2.04–20.5), 65.01 (95% CI, 12.3–343.4). Planar ventilation/perfusion scanning, chest X-ray combined with perfusion scanning and dual-energy computed tomography pulmonary angiography (CTPA) showed sensitivity and specificity of 85.1 and 82.5, 60.0 and 86.0, and 80.8 and 96.0, respectively. Conclusion: CTPA remains the most diagnostically accurate for acute pulmonary embolism diagnosis exhibiting 83% sensitivity and 96% specificity. However, there is evidence for the use of lower-risk, radiation-free alternative imaging modalities if available. Further research is required to substantiate these findings.
Original languageEnglish
Pages (from-to)93-93
Number of pages1
JournalJournal of Medical Radiation Sciences
Volume69
Issue numberS1
DOIs
Publication statusPublished - May 2022

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