An overview of systematic reviews on imaging tests for diagnosis of pulmonary embolism applying different network meta-analytic methods.

PURPOSE: To apply different methods of diagnostic test accuracy network meta-analysis (DTA-NMA) in studies reporting results of five imaging tests for the diagnosis of suspected pulmonary embolism (PE): pulmonary angiography (PA), computed tomography angiography (CTPA), magnetic resonance angiography (MRA), planar ventilation/perfusion (V/Q) scintigraphy and single photon emission computed tomography ventilation/perfusion (SPECT V/Q).

METHODS: We searched four databases MEDLINE (via PubMed), Cochrane Central, Scopus and Epistemonikos from inception until June 2nd , 2022 to identify systematic reviews (SRs) describing diagnostic accuracy of PA, CTPA, MRA, V/Q Scan and SPECT V/Q for suspected PE. Study-level data were extracted from them and pooled using one hierarchical meta-regression approach (HSROC) and two DTA-NMA models to compare accuracy estimates of different imaging tests. Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool and certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation framework.

RESULTS: We identified 13 SRs, synthesizing data from 33 primary studies and for 4 imaging tests (PA, CTPA, MRA and V/Q Scan). HSROC meta-regression model using PA as reference standard showed that MRA had the best overall diagnostic performance with sensitivity=0.93 (95% confidence interval (CI): 0.76, 1.00) and specificity=0.94 (95% CI: 0.84, 0.99). However, NMA-DTA models indicated that V/Q scan had the highest sensitivity while CTPA was most specific.

CONCLUSION: Selecting a different DTA-NMA method to assess multiple diagnostic tests can potentially affect the estimates of diagnostic accuracy. There is no established method, but the choice depends on the data and familiarity with Bayesian setting.