Systematic Review and Meta-Analysis on the Value of Chest CT in the Diagnosis of Coronavirus Disease (COVID-19): Sol Scientiae, Illustra Nos
Systematic Review and Meta-Analysis on the Value of Chest CT in the Diagnosis of Coronavirus Disease (COVID-19): Sol Scientiae, Illustra Nos
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DOI：
10.2214/ajr.20.23391
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发表时间：
2020-12-01
影响因子：
5
通讯作者：
Kwee, Robert M.
中科院分区：
文献类型：
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作者：
Adams, Hugo J. A.;Kwee, Thomas C.;Kwee, Robert M.
OBJECTIVE.本文旨在系统回顾和荟萃分析胸部CT在检测冠状病毒病（COVID-19）中的诊断准确性。材料和方法。系统检索MEDLINE中有关胸部CT检测COVID-19诊断性能的出版物。使用诊断准确性研究2（QUADAS-2）质量评估工具评估方法学质量。采用双变量随机效应模型进行荟萃分析。纳入了6项研究，包括1431例患者。所有6项研究均纳入了COVID-19高风险患者，其中5项研究明确报告仅纳入了有症状的患者。COVID-19的平均患病率为47.9%（范围：276-85.4%）。在所有6项研究中，所有QUADAS-2领域均存在高偏倚或潜在偏倚风险。灵敏度范围为92.9%-970%，特异性范围为25.0%-71.9%，合并估计值分别为94.6%（95% CI，91.9-96.4%）和46.0%（95% CI，31.9-60.7%）。纳入研究的敏感性估计值具有统计学同质性（p = 0.578），特异性估计值具有统计学异质性（p < 0.001）。COVID-19中胸部Cl的诊断准确性研究存在方法学质量问题。胸部CT在有症状的COVID-19高危患者中似乎具有相对较高的敏感性，但不能排除COVID-19。特异性差。沿着这些数据，以及其他当地因素，如COVID-19患病率、可用的实时逆转录酶-聚合酶链反应检测、工作人员、医院和CT扫描能力，可以帮助医疗保健专业人员和政策制定者决定在医院环境中使用胸部CT检测COVID-19。
OBJECTIVE. The purpose of this article is to systematically review and meta-analyze the diagnostic accuracy of chest CT in detecting coronavirus disease (COVID-19).MATERIALS AND METHODS. MEDLINE was systematically searched for publications on the diagnostic performance of chest CT in detecting COVID-19. Met hodologic quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool. Meta-analysis was performed using a bivariate random-effects model.RESULTS. Six studies were included, comprising 1431 patients. All six studies included patients at high risk of COVID-19, and five studies explicitly reported that they included only symptomatic patients. Mean prevalence of COVID-19 was 47.9% (range, 276-85.4%). High or potential risk of bias was present throughout all QUADAS-2 domains in all six studies. Sensitivity ranged from 92.9% to 970%, and specificity ranged from 25.0% to 71.9%, with pooled estimates of 94.6% (95% CI, 91.9-96.4%) and 46.0% (95% CI, 31.9-60.7%), respectively. The included studies were statistically homogeneous in their estimates of sensitivity (p = 0.578) and statistically heterogeneous in their estimates of specificity (p < 0.001).CONCLUSION. Diagnostic accuracy studies on chest Cl in COVID-19 suffer from methodologic quality issues. Chest CT appears to have a relatively high sensitivity in symptomatic patients at high risk of COVID-19, but it cannot exclude COVID-19. Specificity is poor. These data, along with other local factors such as COVID-19 prevalence, available real-time reverse transcriptase-polymerase chain reaction tests, staff, hospital, and CT scanning capacity, can be useful to healthcare professionals and policy makers to decide on the utility of chest CT for COVID-19 detection in the hospital setting.