Diagnostic Value of Computed Tomography in Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-analysis

Figures & data

Figure 1.  A flow chart shows the results of the literature search and selection for this systematic review.

Table 1.  Characteristics of included studies

Study	Yearı	Cases (male/female)		Mean age (years)		Imaging technique	Test index	TP	FP	FN	TN	SEN	SPE
		COPD	Normal	COPD	Normal
Li Kai et al. (24)	2008	40(23/17)	26(16/10)	63.5	61.5	16 MSCT	ALD ex	–	–	–	–	73.9%	93.7%
Chen Shu-jing. (25)	2009	23(23/0)	8(8/0)	67.8	51.8	LDCT	EI ex	–	–	–	–	91.3%	100%
Long Li-ling et al. (26)	2008	40(23/17)	26(16/10)	63.5	61.5	16 MSCT	PI ex	–	–	–	–	96.6%	100%
Miao Fei. (27)	2010	37(26/11)	32(23/9)	64.2	53.4	16 MSCT	BF	–	–	–	–	81.0%	75.0%
Kurashima K et al. (28)	2005	(462/54)	69.0	HRCT	LD	228	102	52	134	-	-
Tsushima K et al. (29)	2010	48(40/8)	2199(1319/880)	61.1	53.5	LDCT	LAA%	–	–	–	–	81.3%	87.5%
Marsh S et al. (30)	2007	22(19/3)	185(88/97)	64.7	54.4	Unclear	LD	–	–	–	–	83.3%	62.8%
Mets OM et al. (31)	2011	1140	63.5	LDCT	Diagnostic Model	274	85	163	618	–	–

TP = number of true positives; FP = number of false positives; FN = number of false negatives; TN = number of true negatives. MSCT = multislice computed tomography; ALD ex = the full expiration average lung density; LDCT = low-dose computed tomography; HRCT = high resolution computed tomography; EI ex = emphysema index in expiration; PI ex = pixel index in maximum expiratory; BF = blood flow; BV = blood volume; LAA% = the percentage of the low attenuation area; LD = lung density; Diagnostic Model = CT emphysema, CT air trapping, BMI, pack-years, and smoking status.

Table 2.  The number of true positives, false positives, false negatives and true negatives were calculated according to each sensitivity and specificity by Review Manager 5.1

Study	COPD	Normal	TP	FP	FN	TN
Li Kai et al. (24)	40	26	30	2	10	24
Chen Shu-jing. (25)	23	8	21	0	2	8
Long Li-ling et al. (26)	40	26	39	0	1	26
Miao Fei. (27)	37	32	30	8	7	24
Tsushima K et al. (29)	48	2199	39	275	9	1924
Marsh S et al. (30)	22	185	18	69	4	116

Table 3.  QUADAS-2 results for studies performed with CT

	Risk of bias				Applicability concerns
Studies	Patient selection	Index test	Reference standard	Flow and timing	Patient selection	Index test	Reference Standard
Li Kai et al. (24)	↑	↑ ↑	↑	↑	↑	↑	↑
Chen Shu-jing. (25)	↑	↑ ↑	↑	↑	↑	↑	↑
Long Li-ling et al. (26)	↑	↑ ↑	↑	↑	↑	↑	↑
Miao Fei. (27)	↑	↑ ↑	↑	↑	↑	↑	↑
Kurashima K et al. (28)	↑	↑ ↑	↑	↑	↑	↑	↑
Tsushima K et al. (29)	↑	↑ ↑	?	↑	↑	↑	↑
Marsh S et al. (30)	↑	?	?	↑	↑	↑	↑
Mets OM et al. (31)	↑	↑	↑ ↑	↑	↑	↑	↑

↑ = Low risk, ↑ ↑ = high risk, ? = unclear risk.

Figure 2.  Bivariate summary estimates of sensitivity and specificity for all of the studies and the corresponding 95% confidence ellipse around these mean values.

Table 4.  Summary estimates for sensitivity, specificity, and diagnostic odds ratio for all studies from the bivariate model

Measure of all test accuracy	Pooled summary measure (95% CI)	Test for heterogeneity
		Chi-squared value	p- value
Sensitivity	0.83(0.73, 0.89)
Specificity	0.87(0.70, 0.95)
Positive Likelihood Ratio(LR+)	6.2(2.5, 15.5)	111.970	<0.001
Negative likelihood Ratio(LR–)	0.20(0.12, 0.34)
Diagnostic odds ratio(DOR)	31(8,116)

Table 5.  Summary estimates for sensitivity, specificity, and diagnostic odds ratio for different text index from the bivariate model

Imaging modality	sensitivity (95% CI)	specificity (95% CI)	LR+(95% CI)	LR–(95% CI)	DOR(95% CI)
LD (N = 4)	0.80(0.74–0.84)	0.77(0.58–0.89)	3.5(1.8–6.9)	0.26(0.20–0.34)	13(6–32)
Others (N = 4)	0.87(0.64–0.96)	0.95(0.66–0.99)	17.5(1.8–171.5)	0.14(0.04–0.45)	127(5–2982)
P-value LD vs. Others	0.8653	0.2355	–	–	0.3100

Comparison between two test indexes.

Abbreviations: LD, Lung Density; Others refers to the 4 studies with the test index (emphysema index in expiration, pixel index in maximum expiratory, blood flow and Diagnostic Model).

Table 6.  Summary estimates for accuracy measures for types of imaging technique from the sROC approach

Measure of test accuracy	Pooled summary measure (95% CI)	Test for heterogeneity
		Chi-squared value	p- value
16 MSCT(N = 3)
Sensitivity	0.85(0.77, 0.91)	10.23	0.006
Specificity	0.88(0.79, 0.94)	11.23	0.004
Positive Likelihood Ratio(LR+)	8.42(1.64, 43.23)	8.43	0.015
Negative likelihood Ratio(LR–)	0.18(0.07, 0.44)	6.96	0.031
Diagnostic odds ratio(DOR)	52.06(6.71, 403.95)	7.71	0.021
LDCT(N = 3)
Sensitivity	0.66(0.61, 0.70)	15.75	<0.001
Specificity	0.88(0.86, 0.89)	2.20	0.333
Positive Likelihood Ratio(LR+)	5.89(4.57, 7.59)	4.46	0.107
Negative likelihood Ratio(LR–)	0.25(0.12, 0.53)	10.28	0.006
Diagnostic odds ratio(DOR)	21.27(8.47, 53.41)	7.18	0.028

Figure 3.  Funnel plot for evaluation of publication bias in all studies.

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