Diagnostic value of multi-slice spiral computed tomography angiography for detecting chest pain triple: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

GUO Qihong ,  LEI Junqiang , WANG Gang , NAN Jiang , SHI Xiaonan , CHEN Zixian , LU Xingru

Radiology Department, the First Hospital of Lanzhou University, Lanzhou, 730000, P.R.China;

Corresponding author：

LEI Junqiang, Email: leijq2011@126.com

Keywords：

Multislice spiral computed tomography angiography; Chest pain triple; Diagnostic test; Meta-analysis

DOI：

10.7507/1672-2531.201711058

Video：

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ObjectivesTo systematically review clinical values of multi-slice spiral computed tomography angiography (MSCTA) in diagnosis of chest pain triple (CPT).MethodsPubMed, EMbase, The Cochrane Library, Web of Science, CNKI, CBM, VIP and WanFang Data databases were searched to collect diagnostic tests on CPT diagnosed by MSCTA from inception to October 2017. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of the included studies. Meta-analysis was performed by Stata 12.0 software. The pooled weighted Sen, Spe, +LR, -LR, and the DOR were calculated, SROC and AUC were drawn.ResultsA total of 11 diagnostic studies were included. The results of meta-analysis showed that the pooled Sen, Spe, +LR, -LR, DOR and AUC of MSCTA for diagnosing CPT were 0.95 (95%CI 0.91 to 0.98), 0.97 (95%CI 0.94 to 0.98), 31.24 (95%CI 15.63 to 62.43), 0.05 (95%CI 0.02 to 0.10), 659.04 (95%CI 236.73 to 1 834.71) and 0.99 (95%CI 0.98 to 1.00), respectively.ConclusionsMSCTA has high sensibility and specificity for diagnosing CPT. Due to limited quantity and quality of the included studies, more high-quality studies are required to verify the above conclusion.

Citation： GUO Qihong, LEI Junqiang, WANG Gang, NAN Jiang, SHI Xiaonan, CHEN Zixian, LU Xingru. Diagnostic value of multi-slice spiral computed tomography angiography for detecting chest pain triple: a meta-analysis. Chinese Journal of Evidence-Based Medicine, 2018, 18(7): 670-675. doi: 10.7507/1672-2531.201711058 Copy

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2.	Foy AJ, Filippone L. Chest pain evaluation in the emergency department. Med Clin North Am, 2015, 99(4): 835-847.
3.	Mark Courtney D. Triple rule out: why it is not ready to roll out. Acad Emer Med, 2013, 20(9): 934-936.
4.	Madder RD, Raff GL, Hickman L, et al. Comparative diagnostic yield and 3-month outcomes of " triple rule-out” and standard protocol coronary CT angiography in the evaluation of acute chest pain. J Cardiovasc Comput Tomogr, 2011, 5(3): 165-171.
5.	Yoon YE, Wann S. Evaluation of acute chest pain in the emergency department: " triple rule-out” Comput tomography angiography. Cardiol Rev, 2011, 19(3): 115-121.
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9.	Lemos AA, Pezzullo JC, Fasani P, et al. Can the unenhanced phase be eliminated from dual-phase CT angiography for chest pain? Implications for diagnostic accuracy in acute aortic intramural hematoma. AJR Am J Roentgenol, 2014, 203(6): 1171-1180.
10.	Litmanovich D, Zamboni GA, Hauser TH, et al. ECG-gated chest CT angiography with 64-MDCT and tri-phasic IV contrast administration regimen in patients with acute non-specific chest pain. Eur Radiol, 2008, 18(2): 308-317.
11.	Schuchlenz H, Weihs W, Botegal D, et al. High-pitch Dual-source CT allows triple-rule-out with a high accuracy and a low radiation dose in real live patients: First experience in nonselected symptomatic patients. Eur Heart J, 2010, 31(23): 292-293.
12.	White CS, Kuo D, Kelemen M, et al. Chest pain evaluation in the emergency department: can MDCT provide a comprehensive evaluation? AJR Am J Roentgenol, 2005, 185(2): 533-540.
13.	吕国士, 徐颖, 左宏, 等. 心电门控下 64 排螺旋 CT 胸部 CT 血管成像对急性胸痛病因快速诊断的价值. 实用医学杂志, 2009, 25(20): 3414-3416.
14.	张蕴, 荐志洁, 赵婷婷, 等. 64 层螺旋 CT 胸痛" 三联”CTA 技术与诊断价值. 中国医学影像技术, 2013, 19(12): 2036-2340.
15.	徐健, 陈军法, 肖华伟, 等. 急性不典型胸痛患者 320 排 CT 心肺血管一站式成像分析. 影像诊断与介入放射学, 2014, 23(4): 340-345.
16.	曹建新, 王一民, 杨诚, 等. 双源 CT 在急性胸痛诊断和鉴别诊断中的临床价值. 放射学实践, 2010, 25(12): 1358-1362.
17.	李宇, 范占明, 余婧, 等. 双源 CT 对急性胸痛的诊断价值. 实用放射学杂志, 2011, 27(1): 51-55.
18.	Whiting PF, Rutjes AW, Westwood ME, et al. QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med, 2011, 155(8): 529-536.
19.	刘海峰, 刘易婧, 许永生, 等. 磁共振成像 DWI 序列诊断乳腺癌淋巴结转移价值的 Meta 分析. 中国循证医学杂志, 2016, 16(11): 1276-1283.
20.	Sechtem U, Achenbach S, Friedrich M, et al. Non-invasive imaging in acute chest pain syndromes. Eur Heart J Cardiovasc Imaging, 2012, 13(1): 69-78.
21.	Patel VG, Brayton KM, Mintz GS, et al. Intracoronary and noninvasive imaging for prediction of distal embolization and periprocedural myocardial infarction during native coronary artery percutaneous intervention. Circ Cardiovasc Imaging, 2013, 6(6): 1102-1114.
22.	Midiri M, La Grutta L, Grassedonio E, et al. Non invasive imaging of myocardial infarction with computed tomography and magnetic resonance. Curr Vasc Pharmacol, 2015, 3(1): 64-77.
23.	Manninen AL, Isokangas JM, Karttunen A, et al. A comparison of radiation exposure between diagnostic CTA and DSA examinations of cerebral and cervicocerebral vessels. AJNR, 2012, 33(11): 2038-2042.
24.	Fernandez D, Delgado S, Oca P, et al. High pitch CT in triple rule-out studies: Radiation dose and image quality compared to multidetector CT. Radiologia, 2015, 57(5): 412-418.
25.	Bossuyt PM, Reitsma JB, Bruns DE, et al. STARD 2015: An updated list of essential items for reporting diagnostic accuracy studies. Clin Chem, 2015, 61(12): 1446-1452.

1. Geyser M, Smith S. Chest pain prevalence, causes, and disposition in the emergency department of a regional hospital in Pretoria. Afr J Prim Health Care Fam Med, 2016, 8(1): e1-e5.
2. Foy AJ, Filippone L. Chest pain evaluation in the emergency department. Med Clin North Am, 2015, 99(4): 835-847.
3. Mark Courtney D. Triple rule out: why it is not ready to roll out. Acad Emer Med, 2013, 20(9): 934-936.
4. Madder RD, Raff GL, Hickman L, et al. Comparative diagnostic yield and 3-month outcomes of " triple rule-out” and standard protocol coronary CT angiography in the evaluation of acute chest pain. J Cardiovasc Comput Tomogr, 2011, 5(3): 165-171.
5. Yoon YE, Wann S. Evaluation of acute chest pain in the emergency department: " triple rule-out” Comput tomography angiography. Cardiol Rev, 2011, 19(3): 115-121.
6. Wnorowski AM, Halpern EJ. Diagnostic yield of triple-rule-out CT in an emergency setting. AJR, 2016, 207(2): 295-301.
7. Chae MK, Kim EK, Jung KY, et al. Triple rule-out computed tomography for risk stratification of patients with acute chest pain. J Cardiovasc Comput Tomogr, 2016, 10(4): 291-300.
8. Johnson TR, Nikolaou K, Becker A, et al. Dual-source CT for chest pain assessment. Eur Radiol, 2008, 18(4): 773-780.
9. Lemos AA, Pezzullo JC, Fasani P, et al. Can the unenhanced phase be eliminated from dual-phase CT angiography for chest pain? Implications for diagnostic accuracy in acute aortic intramural hematoma. AJR Am J Roentgenol, 2014, 203(6): 1171-1180.
10. Litmanovich D, Zamboni GA, Hauser TH, et al. ECG-gated chest CT angiography with 64-MDCT and tri-phasic IV contrast administration regimen in patients with acute non-specific chest pain. Eur Radiol, 2008, 18(2): 308-317.
11. Schuchlenz H, Weihs W, Botegal D, et al. High-pitch Dual-source CT allows triple-rule-out with a high accuracy and a low radiation dose in real live patients: First experience in nonselected symptomatic patients. Eur Heart J, 2010, 31(23): 292-293.
12. White CS, Kuo D, Kelemen M, et al. Chest pain evaluation in the emergency department: can MDCT provide a comprehensive evaluation? AJR Am J Roentgenol, 2005, 185(2): 533-540.
13. 吕国士, 徐颖, 左宏, 等. 心电门控下 64 排螺旋 CT 胸部 CT 血管成像对急性胸痛病因快速诊断的价值. 实用医学杂志, 2009, 25(20): 3414-3416.
14. 张蕴, 荐志洁, 赵婷婷, 等. 64 层螺旋 CT 胸痛" 三联”CTA 技术与诊断价值. 中国医学影像技术, 2013, 19(12): 2036-2340.
15. 徐健, 陈军法, 肖华伟, 等. 急性不典型胸痛患者 320 排 CT 心肺血管一站式成像分析. 影像诊断与介入放射学, 2014, 23(4): 340-345.
16. 曹建新, 王一民, 杨诚, 等. 双源 CT 在急性胸痛诊断和鉴别诊断中的临床价值. 放射学实践, 2010, 25(12): 1358-1362.
17. 李宇, 范占明, 余婧, 等. 双源 CT 对急性胸痛的诊断价值. 实用放射学杂志, 2011, 27(1): 51-55.
18. Whiting PF, Rutjes AW, Westwood ME, et al. QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med, 2011, 155(8): 529-536.
19. 刘海峰, 刘易婧, 许永生, 等. 磁共振成像 DWI 序列诊断乳腺癌淋巴结转移价值的 Meta 分析. 中国循证医学杂志, 2016, 16(11): 1276-1283.
20. Sechtem U, Achenbach S, Friedrich M, et al. Non-invasive imaging in acute chest pain syndromes. Eur Heart J Cardiovasc Imaging, 2012, 13(1): 69-78.
21. Patel VG, Brayton KM, Mintz GS, et al. Intracoronary and noninvasive imaging for prediction of distal embolization and periprocedural myocardial infarction during native coronary artery percutaneous intervention. Circ Cardiovasc Imaging, 2013, 6(6): 1102-1114.
22. Midiri M, La Grutta L, Grassedonio E, et al. Non invasive imaging of myocardial infarction with computed tomography and magnetic resonance. Curr Vasc Pharmacol, 2015, 3(1): 64-77.
23. Manninen AL, Isokangas JM, Karttunen A, et al. A comparison of radiation exposure between diagnostic CTA and DSA examinations of cerebral and cervicocerebral vessels. AJNR, 2012, 33(11): 2038-2042.
24. Fernandez D, Delgado S, Oca P, et al. High pitch CT in triple rule-out studies: Radiation dose and image quality compared to multidetector CT. Radiologia, 2015, 57(5): 412-418.
25. Bossuyt PM, Reitsma JB, Bruns DE, et al. STARD 2015: An updated list of essential items for reporting diagnostic accuracy studies. Clin Chem, 2015, 61(12): 1446-1452.

Chinese Journal of Evidence-Based Medicine

Diagnostic value of multi-slice spiral computed tomography angiography for detecting chest pain triple: a meta-analysis

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