Reliability of Coronary Artery Calcium Severity Assessment on Non-Electrocardiogram-Gated CT: A Meta-Analysis

Abstract

Objective The purpose of this meta-analysis was to investigate the pooled agreements of the coronary artery calcium (CAC) severities assessed by electrocardiogram (ECG)-gated and non-ECG-gated CT and evaluate the impact of the scan parameters. Materials and Methods PubMed, EMBASE, and the Cochrane library were systematically searched. A modified Quality Assessment of Diagnostic Accuracy Studies-2 tool was used to evaluate the quality of the studies. Meta-analytic methods were utilized to determine the pooled weighted bias, limits of agreement (LOA), and the correlation coefficient of the CAC scores or the weighted kappa for the categorization of the CAC severities detected by the two modalities. The heterogeneity among the studies was also assessed. Subgroup analyses were performed based on factors that could affect the measurement of the CAC score and severity: slice thickness, reconstruction kernel, and radiation dose for non-ECG-gated CT. Results A total of 4000 patients from 16 studies were included. The pooled bias was 62.60, 95% LOA were −36.19 to 161.40, and the pooled correlation coefficient was 0.94 (95% confidence interval [CI] = 0.89–0.97) for the CAC score. The pooled weighted kappa of the CAC severity was 0.85 (95% CI = 0.79–0.91). Heterogeneity was observed in the studies (I 2 > 50%, p < 0.1). In the subgroup analysis, the agreement between the CAC categorizations was better when the two CT examinations had reconstructions based on the same slice thickness and kernel. Conclusion The pooled agreement of the CAC severities assessed by the ECG-gated and non-ECG-gated CT was excellent; however, it was significantly affected by scan parameters, such as slice thickness and the reconstruction kernel.

Quality Reporting of Systematic Review and Meta-Analysis According to PRISMA 2020 Guidelines: Results from Recently Published Papers in the Korean Journal of Radiology

“…Briefly, 18 studies (14 univariate and four bivariate) were systematic reviews with meta-analyses [ 14 15 19 20 21 22 23 24 25 26 27 28 29 31 32 33 34 35 ] and six studies were systematic reviews without meta-analyses [ 16 17 18 30 36 37 ]. In terms of the type of data used for analyses, 13 studies used dichotomous data to measure the following outcomes: 1) efficacy or safety of an intervention (proportion of tumor response, recurrence, or treatment-related complications), 2) efficacy of a diagnostic test (proportion of technical failure and unreliable measurement), 3) imaging features in a certain disease (proportion of specific imaging findings), 4) evaluation of study quality or reporting quality (proportion of studies that met the specific criteria), and 5) diagnostic yield [ 14 15 18 19 22 23 24 28 32 33 34 35 36 ]; six studies used time-to-event data to calculate the efficacy of a new intervention or the reliability between overall survival and imaging surrogate markers [ 15 22 31 32 33 34 ]; six studies used diagnostic test data to pool the diagnostic performance of index tests [ 16 25 26 27 29 37 ]; two studies used continuous data to evaluate the agreement and reliability of measurements between imaging methods [ 20 21 ]; one study used descriptive data from imaging protocols in randomized controlled trials of acute ischemic stroke [ 30 ]; and one study used qualitative and quantitative data to assess the health-related quality-of-life in patients with hepatocellular carcinoma [ 17 ]. The number of included studies ranged from 4 to 516, with the majority (83%, 20 out of 24) of the articles including more than 10 studies.…”

“…Seven articles [ 16 24 27 30 31 32 36 ] did not report how many reviewers participated in the evaluation of study eligibility or whether they worked independently (item #8). Eighteen articles [ 16 17 18 19 20 21 22 23 24 25 26 27 28 29 32 34 36 37 ] did not cite the studies that seemed to meet the inclusion criteria, but were excluded in the final stage or did not explain the reason for exclusion (item #16b).…”

“…For randomized controlled trials (RCTs), the Risk of Bias (RoB) tool or revised Jadad scale were implemented [ 32 33 34 ]. For non-RCTs, Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 [ 16 19 20 21 25 26 28 ], QUADAS [ 37 ], Risk of Bias Assessment tool for non-randomized studies [ 14 35 ], Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) [ 17 ], Newcastle Ottawa Scale [ 15 32 34 ], and the National Institute of Health (NIH) assessment tool were used [ 22 23 ]. Among the articles that evaluated the risk of bias, only seven provided the full assessment results of the individual studies [ 17 19 22 23 26 33 34 ].…”

“…Among the articles that reported multiple pooled results, five [ 17 20 21 22 35 ] did not clearly report which studies were included for each outcome synthesis (item #13a). Ten articles [ 14 21 24 25 26 28 29 32 34 37 ] did not report how missing data were handled or how the data were converted for result synthesis (item #13b).…”

“…Finally, 24 publications were included in our analysis ( Fig. 1 ) [ 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 ].…”