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Diagnostic accuracy of dual-energy computed tomography (DECT) to differentiate uric acid from non-uric acid calculi: systematic review and meta-analysis

Published on Jan 24, 2020in European Radiology3.962
· DOI :10.1007/s00330-019-06559-0
Trevor A. McGrath8
Estimated H-index: 8
(U of O: University of Ottawa),
Robert A. Frank4
Estimated H-index: 4
(U of O: University of Ottawa)
+ 4 AuthorsMatthew D. F. McInnes19
Estimated H-index: 19
(Ottawa Hospital Research Institute)
Abstract
Uric acid stone diagnosis is presently done primarily with in vitro analysis of stones. In vivo diagnosis with dual-energy CT (DECT) would allow earlier initiation of therapy with urine alkalinization and avoid surgical intervention. To evaluate if DECT, using stone analysis as reference standard, is sufficiently accurate to replace stone analysis for diagnosis of uric acid stones. Original studies in patients with urolithiasis examined with DECT with stone analysis as the reference standard were eligible for inclusion. MEDLINE (1946–2018), Embase (1947–2018), CENTRAL (August 2018), and multiple urology and radiology conferences were searched. QUADAS-2 was used to assess risk of bias and applicability. Meta-analyses were performed using a bivariate random-effects model. A total of 21 studies (1105 patients, 1442 stones) were included. Fourteen studies containing 662 patients (944 stones) were analyzed in the uric acid dominant target condition (majority of stone composition uric acid): mean sensitivity was 0.88 (95% CI 0.79–0.93) and specificity 0.98 (95% CI 0.96–0.99). Thirteen studies (674 patients, 760 stones) were analyzed in the uric acid–containing target condition (< majority of stone composition uric acid): mean sensitivity was 0.82 (95% CI 0.73–0.89) and specificity 0.97 (95% CI 0.94–0.98). Meta-regression showed no significant variability in test accuracy. Two studies had one or more domains at high risk of bias and there were no concerns regarding applicability. DECT is an accurate replacement test for diagnosis of uric acid calculi in vivo, such that stone analysis could be replaced in the diagnostic pathway. This would enable earlier initiation of urine alkalinization. • DECT for uric acid dominant stones has sensitivity of 0.88 (95% CI 0.79–0.93) and specificity of 0.98 (95% CI 0.96–0.99); uric acid–containing stones had mean sensitivity of 0.82 (95% CI 0.73–0.89) and specificity of 0.97 (95% CI 0.94–0.98). • Meta-regression did not identify any variables (study design, reference standard, dual-energy CT type, dose, risk of bias) that influenced test accuracy. • Only 2 of the 21 included studies had 1 or more domain considered to be at high risk of bias with the majority of domains considered at low risk of bias; there were no concerns regarding applicability in any of the included studies.
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References31
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#1Trevor A. McGrath (U of O: University of Ottawa)H-Index: 8
#2P. M. M. BossuytH-Index: 110
Last. Matthew D. F. McInnes (Ottawa Hospital Research Institute)H-Index: 19
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Last. Nicola Schieda (U of O: University of Ottawa)H-Index: 18
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OBJECTIVE. The purpose of this study is to determine the diagnostic accuracy of dual-energy CT (DECT) using quantitative iodine concentration in patients with renal masses using histopathologic ana...
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#1Jeremy R. Wortman (Brigham and Women's Hospital)H-Index: 6
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#1Matthew D. F. McInnes (Ottawa Hospital Research Institute)H-Index: 19
#2David Moher (Ottawa Hospital Research Institute)H-Index: 74
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Importance Systematic reviews of diagnostic test accuracy synthesize data from primary diagnostic studies that have evaluated the accuracy of 1 or more index tests against a reference standard, provide estimates of test performance, allow comparisons of the accuracy of different tests, and facilitate the identification of sources of variability in test accuracy. Objective To develop the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) diagnostic test accuracy guideline...
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#1Michael J. Connolly (U of O: University of Ottawa)H-Index: 1
#2Matthew D. F. McInnes (U of O: University of Ottawa)H-Index: 19
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Last. P. M. M. Bossuyt (UvA: University of Amsterdam)H-Index: 110
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Abstract Objective To evaluate the handling of multiple readers in imaging diagnostic accuracy systematic reviews-meta-analyses. Methods Search was performed for imaging diagnostic accuracy systematic reviews that performed meta-analysis from 2005–2015. Handling of multiple readers was classified as: 1) averaged; 2) ‘best’ reader; 3) ‘most experienced’ reader; 4) each reader counted individually; 5) random; 6) other; 7) not specified. Incidence and reporting of multiple reader data was assessed ...
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#1Trevor A. McGrath (U of O: University of Ottawa)H-Index: 8
#2Matthew D. F. McInnes (Ottawa Hospital Research Institute)H-Index: 19
Last. P. M. M. BossuytH-Index: 110
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BACKGROUND: We wished to assess the frequency of overinterpretation in systematic reviews of diagnostic accuracy studies. METHODS: MEDLINE was searched through PubMed from December 2015 to January 2016. Systematic reviews of diagnostic accuracy studies in English were included if they reported one or more metaanalyses of accuracy estimates. We built and piloted a list of 10 items that represent actual overinterpretation in the abstract and/or full-text conclusion, and a list of 9 items that repr...
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The objective of this study is to compare in vivo, the accuracy of single-energy CT (SECT) and dual-energy CT (DECT) in renal stone characterization. Retrospective study approved by the IRB. 30 patients with symptomatic urolithiasis who underwent CT on a second-generation dual-source scanner with a protocol that included low-dose 120 kV scan followed by 100/Sn140 kV dual-energy scan have been included. Stone composition was classified as uric acid, cystine or calcium oxalates, and phosphates acc...
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#2Lakshmi Ananthakrishnan (UTSW: University of Texas Southwestern Medical Center)H-Index: 4
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OBJECTIVE. Dual-energy CT (DECT) is being increasingly used for abdominal imaging because it provides incremental benefit of material characterization without significant increase in radiation dose. This article provides an overview of current DECT techniques and use of DECT in urinary tract imaging for assessment of renal masses and urinary calculi characterization and in CT urography. CONCLUSION. Incorporation of DECT into clinical practice and use of its material characterization capabilities...
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