Dual-energy subtraction radiography (DESR): a systematic review and meta-analysis of pulmonary nodule detection

Purpose: This study examined the literature to compare the accuracy, sensitivity, and specificity of dual-energy subtraction radiography (DESR) with conventional radiography (CR) in the detection of pulmonary nodules. To our knowledge, no meta-analysis has been conducted to compare DESR with CR. Material and Methods: The authors searched Pubmed using the terms “Dual-energy subtraction radiography,” and “Dual-Energy Chest Radiography.” Only studies comparing the detection of pulmonary nodules between DESR and CR were included. Studies utilizing artificial intelligence were excluded. The primary study outcomes analyzed were the mean difference of receiver operating characteristic area under the curve (ROC AUC), mean difference of sensitivity, and mean difference of specificity. Results: Twenty-three studies between 1994 and 2022 were included. Of these twenty-three, eighteen reported ROC AUC statistics. The difference between DESR ROC AUC (mean = 0.7702, SD = 0.1361) and CR ROC AUC (mean = 0.7106, SD = 0.1183) was 0.0597 (P<0.001). Sensitivity data was reported for thirteen of the twenty-three selected studies. The difference between DESR sensitivity (mean = 0.5753, SD = 0.1546) and CR sensitivity (mean = 0.4391, SD = 0.1007) was 0.136 (P<0.001). Specificity data were reported for ten of the twenty-three selected studies. The difference between DESR specificity (mean = 0.753, SD = 0.1575) and CR specificity (mean = 0.764, SD = 0.1168) was -0.011 (P=0.767). This was not statistically significant. Conclusions: DESR showed superior sensitivity and ROC AUC values compared with CR in detecting pulmonary nodules. There was no difference in specificity.