增强磁共振成像诊断颈动脉狭窄的系统评价

摘要

目的 探讨增强磁共振成像(MR)与颈动脉造影在颈动脉狭窄(CS)诊断中的临床价值.方法 计算机检索PubMed(1966-2012)、EMBASE(1974-2012)、Cochrane Library(2012年第3期)、CBM (1978-2012)、中国期刊全文数据库CNKI (1994-2012)等,全面收集增强MR与颈动脉造影诊断颈动脉狭窄的研究.按诊断精确性研究质量评估(QUADAS)条目评价纳入研究质量,应用Meta-disc 1.4统计软件进行数据分析.结果 14项研究纳入本系统评价,QVADAS评分平均为64.7％,增强MR与颈动脉造影相比其敏感度、特异度、阳性似然比(+LR)、阴性似然比(-LR)、诊断优势比(DOR)及ROC曲线下面积分别为:94％(95％ CI 92％ ～ 96％)、92％ (95％ CI 90％ ～94％)、12.15(95％ CI 7.64 ～ 19.32)、0.07(95％ CI 0.05 ～0.10)、178.49(95％ CI 108.23 ～ 294.37)和0.98.结论 增强磁共振成像可作为临床上诊断颈动脉狭窄最有效可行的方法.%Objective To evaluate the diagnostic value of contrast enhanced MR imaging for carotid stenosis.Methods By searching PubMed,EMBASE,Cochrane Libarary,CBM,CNKI,et al,collected all diagnostic tests about contrast enhanced MR imaging for carotid stenosis.QUADAS items were used to evaluate the quality of the included studies.The sensitivity,specificity,diagnostic odds ratio (DOR),and systematic receiver operating characteristic curves (SROC) were calculated to assess the diagnostic value of individual diagnostic tests.The data was analyzed by using statistic software Meta disc1.4.Results 14 trials that included a total of 765 patients were analyzed in the systematic review.The summary values of sensitivity,specificity,positive likelihood ratio,negative likelihood ratio,DOR and SROC curve of contrast enhanced MR were 94％ (95％ CI 92％ ～96％),92％ (95％ CI 90％ ～94％),12.15(95％ CI 7.64 ～ 19.32),0.07(95％ CI 0.05 ～0.10),178.49 (95％ CI 108.23 ～ 294.37) and 0.98,respectively.Conclusion Contrast enhanced MR imaging can be regarded as an effective and feasible method for detection the carotid stenosis.