CAJ | 학술논문

目的采用Meta分析评价CT小肠造影(CTE)、MRI小肠造影(MRE)和超声对CD的诊断价值.方法以节段性肠壁增厚和强化为CD影像学诊断指标,内镜、病理学及随访结果为诊断标准,制定检索式及文献纳入标准,搜索并筛选符合纳入标准的CTE、MRE和超声诊断CD的文献.应用诊断试验研究质量评价(QUADAS)量表进行文献质量评价,并比较CTE、MRE和超声在敏感度、特异度、阳性似然比、阴性似然比、阳性预测值(PPV)、阴性预测值(NPV)等方面的诊断效能.结果检索到的2197篇文献中,符合纳入标准的文献共12篇,其中9篇为盲法研究.按3种不同影像技术分组进行QUADAS量表评分,由于有1篇为CTE与MRE的对比性研究,故CTE组文献计6篇,评分均＞10分,均采用盲法；MRE组计4篇文献,均采用盲法,其中3篇评分＞10分；超声组3篇文献中2篇采用盲法,1篇评价为不清楚,1篇评分＞10分.CTE组敏感度(89％)最高,特异度(90％)低于超声组(95％).超声组PPV(93％)、NPV(95 ％)、阳性似然比(15.16)及阴性似然比(0.17)最高,CTE组PPV(91％)、NPV(82％)、阳性似然比(6.25)、阴性似然比(0.15)其次,MRE组敏感度(74％)、特异度(84％)、PPV(80％)、NPV(80％)、阳性似然比(4.18)、阴性似然比(0.33)均低于超声组和CTE组.结论 CTE在CD诊断的敏感度方面优于MRE和超声,但其他诊断评价指标均比超声差.超声对CD的诊断价值虽高,但仍需更多设计良好的大样本试验进行评估.
목적 채용Meta분석평개CT소장조영(CTE)、MRI소장조영(MRE)화초성대CD적진단개치.방법 이절단성장벽증후화강화위CD영상학진단지표,내경、병이학급수방결과위진단표준,제정검색식급문헌납입표준,수색병사선부합납입표준적CTE、MRE화초성진단CD적문헌.응용진단시험연구질량평개(QUADAS)량표진행문헌질량평개,병비교CTE、MRE화초성재민감도、특이도、양성사연비、음성사연비、양성예측치(PPV)、음성예측치(NPV)등방면적진단효능.결과 검색도적2197편문헌중,부합납입표준적문헌공12편,기중9편위맹법연구.안3충불동영상기술분조진행QUADAS량표평분,유우유1편위CTE여MRE적대비성연구,고CTE조문헌계6편,평분균＞10분,균채용맹법；MRE조계4편문헌,균채용맹법,기중3편평분＞10분；초성조3편문헌중2편채용맹법,1편평개위불청초,1편평분＞10분.CTE조민감도(89％)최고,특이도(90％)저우초성조(95％).초성조PPV(93％)、NPV(95 ％)、양성사연비(15.16)급음성사연비(0.17)최고,CTE조PPV(91％)、NPV(82％)、양성사연비(6.25)、음성사연비(0.15)기차,MRE조민감도(74％)、특이도(84％)、PPV(80％)、NPV(80％)、양성사연비(4.18)、음성사연비(0.33)균저우초성조화CTE조.결론 CTE재CD진단적민감도방면우우MRE화초성,단기타진단평개지표균비초성차.초성대CD적진단개치수고,단잉수경다설계량호적대양본시험진행평고.
Objective To evaluate the diagnostic value of computed tomography enteroclysis/enterography (CTE),magnetic resorance enteroclysis/enterography (MRE) and ultrasonography (US) in Crohn's disease (CD) by Meta-analysis.Methods Segmental intestinal wall thickening and strengthening was taken as image diagnostic indicators in CD.Endoscopic and histopathologic findings and follow-up results were set as diagnostic standard.Retrieve and literature inclusion criteria were developed.The papers of CD diagnosed by CTE,MRE and US which met the criteria were searched and screened.The quality of the papers was evaluated by quality assessment of diagnostic accuracy studies (QUADAS).The diagnostic efficacy of CTE,MRE and US was compared,which included sensitivity,specificity,positive likelihood ratio and negative likelihood ratio,positive predictive value (PPV) and negative predictive value (NPV).Results Among the 2197 retrieved literature,a total of 12 papers met the criteria and nine of which were blinded study.The papers were grouped by three different imaging techniques and underwent QUADAS scale scoring.One paper was about CTE and MRE comparative study,so there were six papers in CTE group,the scores of all the six papers were over 10 and all of them were blinded study.There were four papers in MRE group,the scores of three papers were over 10 and all of them were blinded study.There were three papers in US group,the score of one paper was over 10 and two of these three papers were blinded study and one with unclear evaluation.The sensitivity of CTE group was the highest (89 ％),while the specificity (90 ％) was lower than that of US group (95％).The PPV (93％),NPV (95％),positive likelihood ratio (15.16) and negative likelihood ratio (0.17) of US group were the highest,those of CTE were secondary (PPV 91％,NPV 82％,positive likelihood ratio 6.25 and negative likelihood ratio 0.15).The sensitivity (74％),specificity (84％),PPV (80％),NPV (80％),positive likelihood ratio (4.18) and negative likelihood ratio (0.33) of MRE group were lower than both US group and CTE group.Conclusions The sensitivity of CTE in CD diagnosis is better than that of MRE and US,while other diagnostic indicators are poorer than US.Even though US has high diagnostic value in CD,more well designed large sample study were still needed for further evaluation.