Accuracy of AI-Based Algorithms in Pulmonary Embolism Detection on Computed Tomographic Pulmonary Angiography: An Updated Systematic Review and Meta-analysis

Several artificial intelligence (AI) algorithms have been designed for detection of pulmonary embolism (PE) using computed tomographic pulmonary angiography (CTPA). Due to the rapid development of this field and the lack of an updated meta-analysis, we aimed to systematically review the available literature about the accuracy of AI-based algorithms to diagnose PE via CTPA. We searched EMBASE, PubMed, Web of Science, and Cochrane for studies assessing the accuracy of AI-based algorithms. Studies that reported sensitivity and specificity were included. The R software was used for univariate meta-analysis and drawing summary receiver operating characteristic (sROC) curves based on bivariate analysis. To explore the source of heterogeneity, sub-group analysis was performed (PROSPERO: CRD42024543107). A total of 1722 articles were found, and after removing duplicated records, 1185 were screened. Twenty studies with 26 AI models/population met inclusion criteria, encompassing 11,950 participants. Univariate meta-analysis showed a pooled sensitivity of 91.5% (95% CI 85.5-95.2) and specificity of 84.3 (95% CI 74.9-90.6) for PE detection. Additionally, in the bivariate sROC, the pooled area under the curved (AUC) was 0.923 out of 1, indicating a very high accuracy of AI algorithms in the detection of PE. Also, subgroup meta-analysis showed geographical area as a potential source of heterogeneity where the I2 for sensitivity and specificity in the Asian article subgroup were 60% and 6.9%, respectively. Findings highlight the promising role of AI in accurately diagnosing PE while also emphasizing the need for further research to address regional variations and improve generalizability.