Clinical utility of multi-row spiral CT in diagnosing hepatic nodular lesions, gastric cancer, and Crohn's disease: a comprehensive meta-analysis.

Am J Clin Exp Immunol 2024;13(4):165-176 www.ajcei.us /ISSN:2164-7712/AJCEI0157703 Original Article Clinical utility of multi-row spiral CT in diagnosing hepatic nodular lesions, gastric cancer, and Crohn’s disease: a comprehensive meta-analysis Ming Xu1, Yinyun Chen1, Dan Liu1, Lile Wang2, Minghao Wu1 Department of Gastroenterology Medicine, Hunan Provincial People’s Hospital/The First Affiliated Hospital of Hunan Normal University, Changsha 410016, Hunan, China; 2Department of Respiratory Medicine, Hunan Provincial People’s Hospital/The First Affiliated Hospital of Hunan Normal University, Changsha 410016, Hunan, China 1 Received May 11, 2024; Accepted August 17, 2024; Epub August 25, 2024; Published August 30, 2024 Abstract: A retrieval of relevant literature on hepatic nodular lesions, gastric cancer (GC), and Crohn’s disease (CD) was conducted from Chinese and English databases. Meta-analysis was performed using Review Manager 5.4 software and the MIDAS package in Stata 18.0. Results from 11 studies comprising 1847 patients were synthesized. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio with 95% confidence intervals were: 0.91 (0.84-0.95), 0.73 (0.65-0.79), 3.30 (2.60-4.30), 0.13 (0.07-0.23), and 26.00 (12.00-53.00), respectively. Significant statistical heterogeneity was found in sensitivity and specificity (P<0.05), with specificity heterogeneity originating from n, type, and mode (P<0.05). Sensitivity and specificity for n, type, object, and mode were non-heterogeneous (P>0.05). The combined AUC from SROC curve analysis of the 11 studies was 0.85. Deeks’ funnel plot asymmetry test yielded a p-value of 0.01, indicating potential bias across studies in the diagnostic odds ratio funnel plot. Fagan’s nomogram demonstrated that using CT for diagnostic modeling increased the post-test probability of correctly diagnosing hepatic nodular lesions, GC, and CD from 50.00% to 77.00%. Overall, multi-detector CT shows good diagnostic value for hepatic nodular lesions, GC, and CD, supporting its clinical flexibility based on patient-specific considerations. Keywords: Multi-row spiral CT, hepatic nodular lesions, GC, CD, meta-analysis Introduction Hepatic nodules are pathological changes in liver tissue caused by fibrotic proliferation, closely associated with the occurrence and development of various liver diseases such as liver cysts, liver cancer, cirrhosis, and hepatic hemangiomas. Depending on the type of lesion, they are further classified as focal nodular hyperplasia (FNH), intrahepatic micro-nodules, etc [1]. Early examination using multi-row spiral CT is of significant value in improving the cure rate and survival rate of diseases associated with hepatic nodular lesions [2]. Gastric cancer (GC) is a malignant tumor originating from the epithelial cells of the gastric mucosa, predominantly adenocarcinoma. The pathological types are mostly adenocarcinomas, with a 5-year survival rate after surgery for stage I-II GC exceed- ing 90%; pre- and post-operative chemotherapy and radiotherapy can also achieve satisfactory palliative effects [3]. However, due to insufficient early screening rates and lack of targeted therapeutic measures, the 5-year survival rate after surgery for advanced GC has remained relatively low. Xu Q et al. [4] pointed out that radiomics analysis based on enhanced CT can assist in chemotherapy to reduce the pathological staging of advanced GC, thereby improving patients’ quality of life and chemotherapy tolerance. Crohn’s disease (CD) is a disease characterized by chronic inflammatory granulomas in the gastrointestinal tract, affecting the entire tract but primarily the terminal ileum and adjacent colon mucosa [5]. Lesions of CD exhibit segmental, skip distribution, with clinical symptoms mainly including diarrhea, abdominal pain, and weight loss. It is prone to relapse, has https://doi.org/10.62347/SREJ4505 Diagnostic value of CT in hepatic nodules, gastric cancer, and Crohn’s disease multiple complications, and often occurs concomitantly with immune-related diseases such as ankylosing spondylitis and cutaneous immune diseases, presenting symptoms similar to gastric cancer [6]. Therefore, the early diagnosis of CD is often confused with other inflammatory diseases. Clinical studies [7, 8] suggest that CT enterography, routine CT examination, dual-source CT enterography combined with X-ray barium meal have high sensitivity and accuracy in the differential diagnosis of CD, providing support for clinical control of the disease progression and symptom relief. Based on these findings, this study conducted a search and meta-analysis of literature on multirow spiral CT in hepatic nodular lesions, GC, and CD in major databases, aiming to improve the early detection rate and prognosis determination of the diseases. Materials and methods Data source By computer search from January 2004 to January 2024, relevant literature on the diagnosis of hepatic nodular lesions, gastric cancer, and Crohn’s disease using multi-row spiral CT was retrieved. The search was conducted in the China National Knowledge Infrastructure (CNKI) and Wanfang Medical Database using keywords such as multi-row spiral CT, hepatic nodular lesions, gastric cancer, Crohn’s disease, CT, CT enterography, enhanced CT, hepatic nodular lesions, etc. In PudWed, Web of Science, and Springer literature databases, search terms included CT, CTE, MSCT, in Liver Nodular Lesions, Gastric cancer, Advanced gastric cancer, Early gastric cancer, CD, Crohn’s disease, etc. Literature screening Inclusion criteria: ① Literature published from January 2004 to January 2024 with study subjects exclusively Chinese population; ② Availability of CT examination data and confirmation of hepatic nodular lesions/GC/CD diagnosis through other examinations such as MRI, ultrasound, X-ray contrast, histopathology, gastrointestinal endoscopy, etc.; ③ Interval between imaging examinations and pathological examinations ≤1 month; ④ Non-recurrent pa- 166 tients after gastric cancer surgery or radiotherapy; ⑤ Patients providing informed consent for the study; ⑥ Literature providing direct or indirect extraction of true positive (TP), false positive (FP), true negative (TN), and false negative (FN) values. Exclusion criteria: ① Meta-analyses, descriptive studies, case reports, theoretical reviews, personal experience summaries, animal experiments, conference papers; ② Lack of clear evaluation methods, gold standards; ③ Literature not from the aforementioned Chinese and English databases; ④ Unpublished or literature with academic copyright disputes; ⑤ Incomplete literature information, such as unidentified authors, unknown publication years, incomplete clinical and follow-up data, vague research methods, inability to access full text, etc. Literature screening and data extraction The retrieved literature titles were imported into the NoteExpress 3.2 literatur (...truncated)