The diagnostic performance of dual-energy CT in detecting chronic thromboembolic pulmonary hypertension: A systematic-review and Meta-analysis

Abstract

Background and aims

Chronic thromboembolic pulmonary hypertension (CTEPH) is a severe, treatable condition often underdiagnosed due to nonspecific symptoms. Dual-Energy Computed Tomography (DECT) shows promise in the detailed assessment of pulmonary perfusion, providing quantitative values such as perfused blood volume (PBV) and iodine density (ID), potentially helpful in detecting CTEPH. This meta-analysis evaluates the diagnostic accuracy of DECT in detecting CTEPH and its potential role in clinical management.

Methods

Following PRISMA guidelines, a literature search was conducted in PubMed, Web of Science, Scopus, and Embase up to June 2024. Studies providing diagnostic accuracy data for DECT in CTEPH were included. Data were aggregated using a bivariate model in the R statistical programming environment.

Results

Nine studies with 751 participants were included. The pooled sensitivity and specificity of DECT for detecting CTEPH were 87.5 % (95 % CI: 74.8–94.2 %) and 91.2 % (95 % CI: 84.1–95.3 %), with an AUC of 0.95 (95 % CI: 0.87–0.97). The diagnostic accuracy did not significantly differ when distinguishing CTEPH from acute pulmonary thromboembolism (APTE) or non-thromboembolic conditions (p = 0.781). Subgroup analyses based on different quantitative indices and patient vs. segment-based assessments showed no significant differences. Heterogeneity was high, and the risk of bias assessment identified concerns regarding patient selection.

Conclusion

DECT shows promising diagnostic accuracy in detecting CTEPH. However, its suboptimal sensitivity and variability in protocols pose challenges. Future research should focus on identifying optimal diagnostic criteria, indices, and thresholds to standardize DECT use in clinical practice for broader applicability.