SUMMARY RECEIVER OPERATING CHARACTERISTIC CURVES AS A TECHNIQUE FOR METAANALYSIS OF THE DIAGNOSTIC PERFORMANCE OF DUPLEX ULTRASONOGRAPHY INPERIPHERAL ARTERIAL-DISEASE

Rationale and Objectives. We summarized and compared the diagnostic pe rformance of duplex and color-guided duplex ultrasonography in the eva luation of peripheral arterial disease. We present our research as an example of the use of summary receiver operating characteristic (ROC) curves in a meta-analysis of diagnostic test data. Methods. A search o f the English-language medical literature published between 1984 and 1 994 retrieved 48 reports, 14 of which met the inclusion criteria. The analysis was limited to the aortoiliac and femoropopliteal segments be cause only two studies reported results of infrapopliteal arteries. Di agnostic performance of duplex and color-guided duplex, defined as the ability to detect a stenosis of 50-99% or an occlusion, was compared using summary ROC curve methodology. This method takes into account he terogeneity across studies attributable to differences in the threshol d values used. Results. The summary ROC curves demonstrated a high lev el of diagnostic performance for both types of duplex imaging, with co lor-guided duplex scanning being superior (P = .022). For example, at a false-positive rate of .05 (specificity = .95), the analysis predict ed a true-positive rate (sensitivity) of .83 for duplex alone and .93 for color-guided duplex. Differences in the case mix of the study popu lation and study design did not affect the results. Furthermore, sensi tivity analysis did not reveal a strong effect of any single study on the results. Conclusion. For aortoiliac and femoropopliteal arteries, the addition of color flow imaging to duplex scanning improves diagnos tic performance in evaluating peripheral arterial disease.