Transthoracic Sonography for the Detection of Pulmonary Embolism – a Meta-Analysis

Zusammenfassung

Ziel: Strahlenschutz ist seit der Einführung des MSCT-Technologie zu einem Hauptthema in der Radiologie geworden. In einem europaweiten Projekt (SECT) wurden Metaanalysen u. a. über diagnostische Alternativen zum CT initiiert. Diese Studie analysiert die Möglichkeiten des transthorakalen Ultraschalls (TUS) in der Diagnose der Lungenembolie (LE) (5 Studien, 652 Patienten). Material und Methoden: Die Literatur (von 1990–2006) wurde in PubMed und EMBASE durchsucht nach Artikeln, die TUS als diagnostischen Test für die LE benutzten. Eingeschlossen wurden diese, wenn sie die positiven und negativen Raten der Diagnose berichteten. Zwei Reader analysierten die Qualität der Studien. Ergebnisse: Die gepoolte Sensitivität und Spezifität für TUS für LE war 80 % (95 %-KI: 75 %, 83 %) und 93 % (95 %-KI: 89 %, 96 %). Schlussfolgerung: In Zeiten von MSCT ist TUS eine Modalität, die nicht mehr Teil aktueller Strategien in der Bildgebung der LE ist. Angesichts der steigenden Zahl an CT Untersuchungen und der steigenden kollektiven Strahlendosis zeigt diese Metaanalyse, das zumindest für spezielle klinische Situationen TUS als diagnostische Alternative zum CT existiert.

Abstract

Purpose: Radiation protection is a major issue since the implementation of MSCT technology and its widespread indication for the detection of various diseases. In a European-wide trial (SECT) meta-analyses of imaging alternatives to CT have been initiated. This paper focuses on the diagnostic performance of transthoracic ultrasound (TUS) for the diagnosis of pulmonary embolism (PE) (5 studies, 652 patients). Materials and Methods: Medical literature (from 1990 to 2006) in PubMed and EMBASE databases was searched for articles on studies that used TUS as diagnostic tests for PE. Studies were included if they reported the positive and negative rates of PE diagnoses from TUS compared with the rates of PE in CT, MRI or a combination of diagnostic tests. Two readers assessed the quality of the studies. Results: Pooled sensitivity and specificity of TUS for PE were 80 % (95 % CI: 75 %, 83 %) and 93 % (95 % CI: 89 %, 96 %), respectively. Conclusion: In the time of MSCT, TUS is an imaging modality that is no longer part of recent diagnostic algorithms for the diagnosis of PE. Considering the increasing number of requested CT examinations and therefore increasing collective radiation dose, this meta-analysis shows that TUS is a diagnostic alternative for special clinical settings in the work-up of suspected PE that seems to have fallen into oblivion.

Key words

ultrasound - embolism/thrombosis - technology assessment

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