A total of 16 studies (n=1,139) were included. Ten studies (n=630) assessed the diagnostic accuracy of TEE, 3 studies (n=117) assessed helical CT and 7 studies (n=392) assessed MRI. Three studies assessed more than one imaging technique.
TEE (10 studies): the pooled estimates of sensitivity and specificity were 98 (95% CI: 95, 99) and 95 (95% CI: 92, 97), respectively. The pooled estimates of positive and negative likelihood ratios were 14.1 (95% CI: 6.0, 33.2) and 0.04 (95% CI: 0.02, 0.08), respectively. The pooled estimate of DOR was 6.1 (95% CI: 5.0, 7.2). Chi-squared tests indicated the presence of significant between-study heterogeneity for specificity and positive likelihood ratio.
Helical CT (3 studies): the pooled estimates of sensitivity and specificity were 100 (95% CI: 96, 100) and 98 (95% CI: 87, 99), respectively. The pooled estimates of positive and negative likelihood ratios were 13.9 (95% CI: 4.2, 46.0) and 0.02 (95% CI: 0.01, 0.11), respectively. The pooled estimate of DOR was 6.5 (95% CI: 4.4, 8.7). Chi-squared tests indicated the presence of significant between-study heterogeneity for sensitivity.
MRI (7 studies): the pooled estimates of sensitivity and specificity were 98 (95% CI: 95, 99) and 98 (95% CI: 95, 100), respectively. The pooled estimates of positive and negative likelihood ratios were 25.3 (95% CI: 11.1, 57.1) and 0.05 (95% CI: 0.03, 0.10), respectively. The pooled estimate of DOR was 6.8 (95% CI: 5.5, 8.0). Chi-squared tests indicated no significant between-study heterogeneity.
There was no evidence of a threshold effect for any of the imaging techniques assessed.
The funnel plot and Kendall correlation coefficient suggested the absence of publication bias.