PURPOSE To examine the diagnostic accuracy of spectral CT pulmonary angiography (S-CTPA) using ventilation-perfusions lung scintigraphy (V/Q-scan) as a reference standard in the diagnosis of acute or chronic pulmonary embolism (APE/CPE) and chronic thromboembolic pulmonary hypertension (CTEPH). METHODS PubMed, Embase, Scopus, and Web of Science were searched for the period from 1 Jan 2006 to 7 Feb 2019; eligible studies had > 10 patients over 18 years old, a diagnostic outcome of PE or CTEPH, and used V/Q scan as a reference standard. Bias and applicability were assessed using QUADAS-2 tools. Sensitivities, specificities, and predictive values were noted or calculated from available information. Meta-analysis employed a fixed-effects model of Mantel and Haenszel. Heterogeneity was assessed with I-squared statistics. RESULTS Four hundred ninety-three unique records were identified. Following screening by title, 53 studies were included in the abstract and full-text assessment. A total of six articles were included; four were suitable for a meta-analysis. Pooled sensitivity was 94.2% (95% CI, 88.3-100%), pooled specificity was 88.5% (95% CI, 81.3-95.6%), and positive and negative predictive values were 87.8% (95% CI, 80.3-95.4%) and 94.5% (95% CI, 89.3-99.7%), respectively. CONCLUSION Data on S-CTPA for PE/CTEPH remains promising, but limited; only small studies with methodological issues are available. Evidence is best for CPE/CTEPH whereas no firm conclusions are possible for APE. There is a need for larger, prospective studies with a robust composite reference standard including state-of-the-art CTPA and V/Q-scans. KEY POINTS • S-CTPA has high sensitivity and specificity for perfusion defects in patients with PE or CPETH. • Methodological issues and diversity of reference standards were found in the small number of included studies. • There is a need for larger prospective studies with more robust composite reference standards.

中文翻译：

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与闪烁显像相比，CT的系统文献回顾和荟萃分析可诊断急性和慢性肺栓塞。

目的以通气灌注肺闪烁显像（V / Q-scan）为参考标准，检查频谱CT肺血管造影（S-CTPA）的诊断准确性，作为诊断急性或慢性肺栓塞（APE / CPE）和慢性血栓栓塞的参考标准肺动脉高压（CTEPH）。方法检索2006年1月1日至2019年2月7日的PubMed，Embase，Scopus和Web of Science；符合条件的研究有10名18岁以上的患者，PE或CTEPH的诊断结果，并使用V / Q扫描作为参考标准。使用QUADAS-2工具评估偏差和适用性。敏感性，特异性和预测值已记录或从可用信息中计算得出。荟萃分析采用了Mantel和Haenszel的固定效应模型。异质性通过I平方统计进行评估。结果鉴定出493条独特记录。按标题筛选后，摘要和全文评估中包括53项研究。总共包括六篇文章；有四个适合进行荟萃分析。合并敏感性为94.2％（95％CI，88.3-100％），合并特异性为88.5％（95％CI，81.3-95.6％），阳性和阴性预测值为87.8％（95％CI，80.3-95.4％） ）和94.5％（95％CI，89.3-99.7％）。结论PE / CTEPH的S-CTPA数据仍然很有希望，但数量有限。仅提供有关方法论问题的小型研究。CPE / CTEPH的证据最好，而APE则没有确切的结论。需要使用健壮的复合参考标准进行更大规模的前瞻性研究，其中包括最新的CTPA和V / Q扫描。要点•S-CTPA对PE或CPETH患者的灌注缺陷具有高敏感性和特异性。•在纳入的研究中，发现方法学问题和参考标准的多样性。•需要使用更强大的复合参考标准进行更大规模的前瞻性研究。