CAJ | 학술논문

目的采用荟萃(Meta)分析法定量评价椎间盘突出症的CT和MRI诊断价值与效能.方法检索PubMed数据库、Cochrane图书馆、OVID数据库以及中国期刊网1980至2010年公开发表的英文、中文文献,按照Cochrane协作网推荐的诊断试验纳入标准筛选文献,提取纳入研究各文献的诊断信息真阳性值、假阳性值、真阴性值、假阴性值.采用Meta-Disc version 1.4软件、SPSS 13.0软件、Comprehensive Meta-analysis version 2软件,对数据进行统计学处理,包括异质性检验,确定相应的效应模型予以加权定量合并;对纳入文献进行发表性偏倚分析;计算汇总灵敏性和汇总特异性及其95%可信区间;绘制汇总受试者工作特征曲线(SROC)并计算曲线下面积,对CT、MRI对腰椎间盘突出的诊断性能进行概括和评价,最后进行敏感性分析.结果按照纳入标准共获取文献9篇,结果显示,CT诊断腰椎间盘突出症的汇总灵敏性和特异性及95%可信区间为0.73(0.68～0.77)和0.78(0.72～0.82),MRI诊断腰椎间盘突出症的汇总灵敏性和特异性及95%可信区间为0.88(0.83～0.91)和0.79(0.71～0.87),CT和MRI汇总灵敏性的差异有统计学意义(P＜0.05),CT和MRI汇总特异性的差异无统计学意义(P＞0.05);CT和MRI的SROC曲线下面积分别为83.5%和88.8%,两者差异有统计学意义(P＜0.05).结论经Meta分析和统计学检验,MRI诊断的准确性优于CT.
목적 채용회췌(Meta)분석법정량평개추간반돌출증적CT화MRI진단개치여효능.방법 검색PubMed수거고、Cochrane도서관、OVID수거고이급중국기간망1980지2010년공개발표적영문、중문문헌,안조Cochrane협작망추천적진단시험납입표준사선문헌,제취납입연구각문헌적진단신식진양성치、가양성치、진음성치、가음성치.채용Meta-Disc version 1.4연건、SPSS 13.0연건、Comprehensive Meta-analysis version 2연건,대수거진행통계학처리,포괄이질성검험,학정상응적효응모형여이가권정량합병;대납입문헌진행발표성편의분석;계산회총령민성화회총특이성급기95%가신구간;회제회총수시자공작특정곡선(SROC)병계산곡선하면적,대CT、MRI대요추간반돌출적진단성능진행개괄화평개,최후진행민감성분석.결과 안조납입표준공획취문헌9편,결과현시,CT진단요추간반돌출증적회총령민성화특이성급95%가신구간위0.73(0.68～0.77)화0.78(0.72～0.82),MRI진단요추간반돌출증적회총령민성화특이성급95%가신구간위0.88(0.83～0.91)화0.79(0.71～0.87),CT화MRI회총령민성적차이유통계학의의(P＜0.05),CT화MRI회총특이성적차이무통계학의의(P＞0.05);CT화MRI적SROC곡선하면적분별위83.5%화88.8%,량자차이유통계학의의(P＜0.05).결론 경Meta분석화통계학검험,MRI진단적준학성우우CT.
Objective To evaluate the diagnostic performances of CT and MRI in patients with lumbar intervertebral disc herniation through the Meta analytical method. Method The relevant English and Chinese articles published between 1980 and 2010 were searched in PubMed, Medline, Ovid database,Cochrane library and Chinese Periodical Web. According to the criteria for diagnostic researches published by Cochrane Method Group on Screening and Diagnostic Tests, each article was critically appraised and screened with regards to the absolute numbers of true-positive, false-negative, true-negative and falsepositive. Statistical analysis was performed by the Meta-Disc version 1.4, SPSS 13. 0 and Comprehensive Meta-analysis version Ⅱ. Heterogeneity was tested and publication bias analyzed. And the pooled weighted sensitivity and specificity and the corresponding 95% CI were calculated. The summary receiver operating characteristic (SROC) curve was performed and the area under the curve (AUG) calculated to summarize and evaluate the diagnostic efficiency of CT and MRI in lumbar intervertebral disc herniation. Finally a sensitivity analysis was performed. Results According to the criteria of internalization, 9 articles were included. Among them, the themes were CT ( n = 3 ), MRI ( n = 3 ) and CT & MRI ( n = 3 ). Eight was prospectively studied and one retrospectively. At the diagnosis of lumbar intervertebral disc herniation, the pooled weighted sensibility and specificity and 95% confidence interval and area under SROC curve for CT to the lumbar intervertebral disc herniation was 0. 73 ( 0. 68-0. 77 ), 0. 78 ( 0. 72-0. 82 ) and 83.5%respectively. The MRI was 0. 88 ( 0. 83-0. 91 ), 0. 79 ( 0. 71-0. 87 ) and 88. 8% respectively. There was statistically significant difference in the pooled weighted sensibility ( P ＜ 0. 05 ); No statistically significant difference was found in the pooled weighted specificity ( P ＞ 0. 05 ); And there was statistically significant difference in the AUG curve ( P ＜ 0. 05 ). Conclusion After a meta-analysis of the diagnostic value of CT and MRI for the lumbar intervertebral disc herniation, MRI is more accurate than CT in the diagnosis of lumbar intervertebral disc herniation.