MRA诊断颈动脉重度狭窄与闭塞准确性的Meta分析

摘要

Objective: To systematically evaluate the diagnostic accuracy of severe carotid stenosis and occlusion by magnetic resonance angiography (MRA) using a meta-analysis method. Methods: Studies were located through electronic searches of the PubMed,EBSCO,OVID,Springer,Cochrane library database,CNKI, (from the date of establishment of the databases to November 2011). Bibliographies of the retrieved articles were also checked. All the studies concerning the diag-nosis of severe carotid stenosis and occlusion using MRA had been searched and reviewed,and the studies with the DSA as the gold standard were adopted as eligible. Subsequently, the characteristics of the included articles were appraised and ex-tracted. Data on accuracy of included studies were extracted for further heterogeneity exploring, statistical pooling and SROC (summary receiver operating characteristics) analyzing using the Meta DiScl. 4 software. Results: Totally 23 studies were met the inclusion criteria. The heterogeneity was found in these studies. The pooled accuracy indicators like sensitivity, specificity, and diagnostic odds ratio (DOR) were 0. 88(0. 86 ～ 0. 91), 0. 94 (0. 92 ～ 0. 95) 、191. 19 (108. 68 ～ 336. 34),re-spectively. The area under of SROC curve was 0. 9773 and the Q index was 0. 9322. Conclusion: MRA for the diagnosis of severe carotid stenosis and occlusion yields comparably high diagnostic accuracy. MRA, being widely used clinically, is very important for clinical physicians to choose the optimal therapeutic approach. Furthermore, MRA might replace DSA as the standardize technique for diagnosis of this disease in the future.%目的:系统评价MRA诊断颈动脉重度狭窄与闭塞的准确性.方法:采用计算机检索PubMed、EBSCO、Ovid、Springer和Cochrane图书馆数据库以及CNKI相关文献(起止时间均从建库至2011年11月),同时检索纳入上述文献的参考文献.纳入探讨以DSA造影为诊断金标准的MRA诊断颈动脉重度狭窄与闭塞的文献.采用MetaDiSc1.4软件检验研究间的异质性、对诊断符合率进行Meta分析,并进行综合受试者工作特征(SROC)分析.结果:符合纳入文献22篇,各研究之间存在异质性,按照随机效应模型计算总敏感度、特异度、诊断优势比及其95%可信区间分别为0.88(0.86~0.91)、0.94(0.92~0.95)、191.19 (108.68~336.34).SROC曲线下面积(AUC)为0.9773,Q指数为0.9322.结论:MRA诊断重度颈动脉狭窄与闭塞准确性较高,可广泛应用于临床,指导临床选择最佳治疗方案.随着MRI影像检查方法的发展,将来有可能替代DSA金标准的诊断作用.