Dual-source CT in the detection of coronary artery disease: a Meta analysis

Objective: To conduct a Meta analysis based evaluation of dual-source computed tomography (DSCT) in the diagnosis of coronary artery disease (CAD). Methods: Literatures published from January 2006 to July 2009, including in English or Chinese languages, were searched in Medline, China National Knowledge Infrastructure (CNKI), and Chinese Medical Association Digital Periodicals (CMADP). A study was enrolled if it: (1) used DSCT angiography as the diagnostic test for the detection of significant coronary stenosis ( ≥ 50% diameter stenosis) in patients with suspected CAD; (2) used coronary angiography as the reference standard. The pooled sensitivity and specificity of the 95% confidence interval (95% CI) were acquired based on the bivariate random-effects model. Hierarchical weighted symmetric summary receiver-operating curve (HSROC) was also estimated. The pooled likelihood ratios were calculated based on the pooled sensitivity and specificity. Combined with the pooled likelihood ratios, the clinical utility of the results was estimated according to Bayes' theory. Results: Total of ten articles enrolled in this study, included 1271 patients. The mean rate of non-evaluable patients and segments were 5.6% (33/590) and 2.3% (271/11 745), respectively. The pooled statistical results were as follows: the sensitivity and specificity were 99% (97%-99%) and 86% (79%-90%), respectively; the positive and negative likelihood ratio were 6.84 and 0.01, respectively. If a pre-test probability was below 84%, the likelihood of disease was less than 5% on a negative diagnosis of DSCT. If a pre-test probability was above 13%, the likelihood of' disease was more than 50% on a positive diagnosis of DSCT. Conclusions: DSCT angiography presents good diagnostic performance in the detection of CAD; however, it could not completely replace conventional coronary angiography. (authors)