Low-dose Computed Tomography (CT) for the Diagnosis of Congenital Heart Disease in Children: A Meta-analysis

BACKGROUND Low dose CT has become a promising examination method for the diagnosis of Congenital heart disease (CHD) in children because it has the low radiation dose, but it has not been widely accepted as an alternative to standard-dose CT in clinical applications due to concerns about image quality. Therefore, we suggest that the diagnostic accuracy, image quality, and radiation dose of low-dose CT for CHD in children should be fully explored through a meta-analysis of existing studies. METHODS A comprehensive search was performed to identify relevant English and Chinese articles (from inception to May 2019). All selected studies concerned the diagnosis of CHD in children using low-dose CT. The accuracy of low-dose CT was determined by calculating pooled estimates of sensitivity, specificity, diagnostic odds ratio, and likelihood ratio. Pooling was conducted using a bivariate generalized linear mixed model. Forest plots and summary receiver operating characteristic (SROC) curves were generated. RESULTS Ten studies, accounting for 577 patients, met the eligibility criteria. The pooled sensitivity and specificity were 0.95 (95% confidence interval (CI) 0.92-0.97) and 1.00 (95% CI 1.00-1.00), respectively. The pooled diagnostic odds ratio, positive likelihood ratio, and negative likelihood ratio of low-dose CT were 12705.53 (95% CI 5065.00-31871.73), 671.29 (95% CI 264.77-1701.97), and 0.05 (95% CI 0.03-0.08), respectively. Additionally, the area under the SROC curve was 1.00 (95% CI 0.99-1.00), suggesting that low-dose CT is an excellent diagnostic tool for CHD in children. CONCLUSION Low-dose CT, especially with a prospective ECG-triggering mode, provides excellent imaging quality and high diagnostic accuracy for CHD in children.