Value of imaging examinations in diagnosing lumbar disc herniation: A systematic review and meta-analysis

PURPOSE: To systematically review the clinical value of three imaging examinations (Magnetic Resonance Imaging, Computed Tomography, and myelography) in the diagnosis of Lumbar Disc Herniation. METHODS: Databases including PubMed, Embase, The Cochrane Library, Web of Science, CBM, CNKI, WanFang Data, and VIP were electronically searched to collect relevant studies on three imaging examinations in the diagnosis of Lumbar Disc Herniation from inception to July 1, 2021. Two reviewers using the Quality Assessment of Diagnostic Accuracy Studies-2 tool independently screened the literature, extracted the data, and assessed the risk of bias of included studies. Then, meta-analysis was performed by using Meta-DiSc 1.4 software and Stata 15.0 software. RESULTS: A total of 38 studies from 19 articles were included, involving 1,875 patients. The results showed that the pooled Sensitivity, pooled Specificity, pooled Positive Likelihood Ratio, pooled Negative Likelihood Ratio, pooled Diagnostic Odds Ratio, Area Under the Curve of Summary Receiver Operating Characteristic, and Q* were 0.89 (95%CI: 0.87–0.91), 0.83 (95%CI: 0.78–0.87), 4.57 (95%CI: 2.95–7.08), 0.14 (95%CI: 0.09–0.22), 39.80 (95%CI: 18.35–86.32), 0.934, and 0.870, respectively, for Magnetic Resonance Imaging. The pooled Sensitivity, pooled Specificity, pooled Positive Likelihood Ratio, pooled Negative Likelihood Ratio, pooled Diagnostic Odds Ratio, Area Under the Curve of Summary Receiver Operating Characteristic, and Q* were 0.82 (95%CI: 0.79–0.85), 0.78 (95%CI: 0.73–0.82), 3.54 (95%CI: 2.86–4.39), 0.19 (95%CI: 0.12–0.30), 20.47 (95%CI: 10.31–40.65), 0.835, and 0.792, respectively, for Computed Tomography. The pooled Sensitivity, pooled Specificity, pooled Positive Likelihood Ratio, pooled Negative Likelihood Ratio, pooled Diagnostic Odds Ratio, Area Under the Curve of Summary Receiver Operating Characteristic, and Q* were 0.79 (95%CI: 0.75–0.82), 0.75 (95%CI: 0.70–0.80), 2.94 (95%CI: 2.43–3.56), 0.29 (95%CI: 0.21–0.42), 9.59 (95%CI: 7.05–13.04), 0.834, and 0.767 respectively, for myelography. CONCLUSION: Three imaging examinations had high diagnostic value. In addition, compared with myelography, Magnetic Resonance Imaging had a higher diagnostic value.