The Diagnostic Accuracy of Low-Dose Computed Tomography in Diagnosing Urolithiasis: A Systematic Review and Meta-Analysis

Abstract Background: Urolithiasis is a prevalent health issue all over the world,To evaluate the diagnostic accuracy of low-lose computed tomography(LDCT) for detecting urolithiasis. Methods: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was followed. PubMed, EMBASE and The Cochrane Library were searched for original diagnostic studies to identify all relevant studies published prior to May 2020. The index test was LDCT, and the reference standards were comprehensive diagnosis or standard-dose CT (SDCT). Results: 17 studies with 1,761 patients and 2,053 stones were included for the quantitative analysis. The pooled sensitivity was 0.95 (95%CI: 0.93-0.97) in patient-based studies and 0.86 (95%CI: 0.76-0.93) in urolithiasis-based studies. The pooled specificity of LDCT were 0.97 (95%CI: 0.95-0.99) in patient-based studies and 0.98 (95%CI: 0.63-1.00) in urolithiasis-based studies. The Fagan nomogram of LDCT for diagnosis of urolithiasis showed that the probability of urolithiasis is 98% if the LDCT scan is positive and 6% if the LDCT scan is negative. The likelihood ratio plot showed that the summary positive pooled likelihood ratio (LRP) and negative likelihood ratio (LRN) for LDCT was in the left upper quadrant(LUQ) area. Conclusions: LDCT has excellent diagnostic value in urolithiasis. LDCT can detect the urolithiasis specifically, but is limited to differentiate the contents of the stones.