Systematic Review and Meta-Analysis Investigating the Diagnostic Yield of Dual-Energy CT for Renal Mass Assessment

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Abstract
OBJECTIVE. The objective of our study was to perform a systematic review and meta-analysis to evaluate the diagnostic accuracy of dual-energy CT (DECT) for renal mass evaluation. MATERIALS AND METHODS. In March 2018, we searched MEDLINE, Cochrane Database of Systematic Reviews, Embase, and Web of Science databases. Analytic methods were based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Pooled estimates for sensitivity, specificity, and diagnostic odds ratios were calculated for DECT-based virtual monochromatic imaging (VMI) and iodine quantification techniques as well as for conventional attenuation measurements from renal mass CT protocols. I2 was used to evaluate heterogeneity. The methodologic quality of the included studies and potential bias were assessed using items from the Quality Assessment Tool for Diagnostic Accuracy Studies 2 (QUADAS-2). RESULTS. Of the 1043 articles initially identified, 13 were selected for inclusion (969 patients, 1193 renal masses). Cumulative data of sensitivity, specificity, and summary diagnostic odds ratio for VMI were 87% (95% CI, 80–92%; I2, 92.0%), 93% (95% CI, 90–96%; I2, 18.0%), and 183.4 (95% CI, 30.7–1093.4; I2, 61.6%), respectively. Cumulative data of sensitivity, specificity, and summary diagnostic odds ratio for iodine quantification were 99% (95% CI, 97–100%; I2, 17.6%), 91% (95% CI, 89–94%; I2, 84.2%), and 511.5 (95% CI, 217–1201; I2, 0%). No significant differences in AUCs were found when comparing iodine quantification to conventional attenuation measurements (p = 0.79). CONCLUSION. DECT yields high accuracy for renal mass evaluation. Determination of iodine content with the iodine quantification technique shows diagnostic accuracy similar to conventional attenuation measurements from renal mass CT protocols. The iodine quantification technique may be used to characterize incidental renal masses when a dedicated renal mass protocol is not available.

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