CAJ | 학술논문

目的比较采用体层摄影术（CT）、磁共振成像（MRI）图像进行肝体积影像学测量的准确性。方法电子检索Cochrane图书馆、中英文文摘数据库（Medline、Embase、中国生物医学文摘数据库）和期刊全文数据库（Springer、OVID、Sciencedirect、Ebsco、CNKI、万方、维普等），获得利用CT或MRI设备测量全肝体积的中英文文献，根据Cochrane协作网推荐的诊断试验纳入标准筛选文献，根据CT、MRI成像设备分组后进行质量评价，采用基于统计分析软件R的循证医学软件包Meta对纳入文献提取信息进行异质性检验，根据异质性检验结果选择恰当的效应量合并模型进行荟萃分析，分别对纳入的CT和MRI研究进行加权合并及组间比较，合并效应量为影像学测量肝体积和实际肝体积的加权平均差，最后进行敏感性分析和发表性偏倚分析。结果符合纳入标准的17篇文献报道了37项研究，包括351例患者。异质性检验显示CT组（I2＝0%，Q＝4.93，P＝0.9998）和MRI组（I2＝0%，Q＝0.92，P＝1）纳入研究均不具异质性。各组效应量合并采用固定效应模型，CT和MRI组影像学测量肝体积和实际肝体积的加权均数差值分别为21.7063 ml〔95％可信区间（95%CI）＝-8.0154～51.4640 ml〕和20.9518 ml（95％CI＝-60.4360～102.3395 ml）。两组的影像学测量肝体积和实际肝体积差异均无统计学意义（CT组：Z＝1.4297，P＝0.1528；MRI组：Z＝0.5046，P＝0.6139），两组的汇总结果差异也无统计学意义（Q＝0，P＝1）。各组汇总结果稳定性好，敏感性分析中逐一排除纳入研究或改变效应量合并模型时，合并结果无明显变化，各纳入研究不存在发表性偏倚，漏斗图各纳入研究对称分布，Deeks线性回归分析不存在显著性（CT组：t＝-1.8820， P＝0.0752；MRI组：t＝0.0015，P＝0.9989）。结论采用CT和MRI图像都可以进行准确的肝体积影像学测量，可以根据患者的具体情况，选择适合患者利益的图像采集方法。目的比較採用體層攝影術（CT）、磁共振成像（MRI）圖像進行肝體積影像學測量的準確性。方法電子檢索Cochrane圖書館、中英文文摘數據庫（Medline、Embase、中國生物醫學文摘數據庫）和期刊全文數據庫（Springer、OVID、Sciencedirect、Ebsco、CNKI、萬方、維普等），穫得利用CT或MRI設備測量全肝體積的中英文文獻，根據Cochrane協作網推薦的診斷試驗納入標準篩選文獻，根據CT、MRI成像設備分組後進行質量評價，採用基于統計分析軟件R的循證醫學軟件包Meta對納入文獻提取信息進行異質性檢驗，根據異質性檢驗結果選擇恰噹的效應量閤併模型進行薈萃分析，分彆對納入的CT和MRI研究進行加權閤併及組間比較，閤併效應量為影像學測量肝體積和實際肝體積的加權平均差，最後進行敏感性分析和髮錶性偏倚分析。結果符閤納入標準的17篇文獻報道瞭37項研究，包括351例患者。異質性檢驗顯示CT組（I2＝0%，Q＝4.93，P＝0.9998）和MRI組（I2＝0%，Q＝0.92，P＝1）納入研究均不具異質性。各組效應量閤併採用固定效應模型，CT和MRI組影像學測量肝體積和實際肝體積的加權均數差值分彆為21.7063 ml〔95％可信區間（95%CI）＝-8.0154～51.4640 ml〕和20.9518 ml（95％CI＝-60.4360～102.3395 ml）。兩組的影像學測量肝體積和實際肝體積差異均無統計學意義（CT組：Z＝1.4297，P＝0.1528；MRI組：Z＝0.5046，P＝0.6139），兩組的彙總結果差異也無統計學意義（Q＝0，P＝1）。各組彙總結果穩定性好，敏感性分析中逐一排除納入研究或改變效應量閤併模型時，閤併結果無明顯變化，各納入研究不存在髮錶性偏倚，漏鬥圖各納入研究對稱分佈，Deeks線性迴歸分析不存在顯著性（CT組：t＝-1.8820， P＝0.0752；MRI組：t＝0.0015，P＝0.9989）。結論採用CT和MRI圖像都可以進行準確的肝體積影像學測量，可以根據患者的具體情況，選擇適閤患者利益的圖像採集方法。
목적비교채용체층섭영술（CT）、자공진성상（MRI）도상진행간체적영상학측량적준학성。방법전자검색Cochrane도서관、중영문문적수거고（Medline、Embase、중국생물의학문적수거고）화기간전문수거고（Springer、OVID、Sciencedirect、Ebsco、CNKI、만방、유보등），획득이용CT혹MRI설비측량전간체적적중영문문헌，근거Cochrane협작망추천적진단시험납입표준사선문헌，근거CT、MRI성상설비분조후진행질량평개，채용기우통계분석연건R적순증의학연건포Meta대납입문헌제취신식진행이질성검험，근거이질성검험결과선택흡당적효응량합병모형진행회췌분석，분별대납입적CT화MRI연구진행가권합병급조간비교，합병효응량위영상학측량간체적화실제간체적적가권평균차，최후진행민감성분석화발표성편의분석。결과부합납입표준적17편문헌보도료37항연구，포괄351례환자。이질성검험현시CT조（I2＝0%，Q＝4.93，P＝0.9998）화MRI조（I2＝0%，Q＝0.92，P＝1）납입연구균불구이질성。각조효응량합병채용고정효응모형，CT화MRI조영상학측량간체적화실제간체적적가권균수차치분별위21.7063 ml〔95％가신구간（95%CI）＝-8.0154～51.4640 ml〕화20.9518 ml（95％CI＝-60.4360～102.3395 ml）。량조적영상학측량간체적화실제간체적차이균무통계학의의（CT조：Z＝1.4297，P＝0.1528；MRI조：Z＝0.5046，P＝0.6139），량조적회총결과차이야무통계학의의（Q＝0，P＝1）。각조회총결과은정성호，민감성분석중축일배제납입연구혹개변효응량합병모형시，합병결과무명현변화，각납입연구불존재발표성편의，루두도각납입연구대칭분포，Deeks선성회귀분석불존재현저성（CT조：t＝-1.8820， P＝0.0752；MRI조：t＝0.0015，P＝0.9989）。결론채용CT화MRI도상도가이진행준학적간체적영상학측량，가이근거환자적구체정황，선택괄합환자이익적도상채집방법。
ObjectiveTo compare the accuracy of radiologically estimated liver volume by computed tomography(CT) and magnetic resonance imaging(MRI).Methods Cochrane library, abstract databases〔Medline,Embase,China biology medicine disc(CMBdisc)〕and full text databases(Springer,OVID, Sciencedirect,Ebsco,CNKI,WanFang and VIP) were searched for published papers on whole liver volumetry with CT or MRI modality. Inclusion criteria were based on validity criteria for diagnostic research published by the Cochrane collaboration. Eligible papers were grouped according to imaging modality(CT or MRI)and evaluated for quality before data extraction. With meta-analysis package Meta of R software, the statistical model used to pool the result was selected according to result of heterogeneity test. Group-wise meta-analysis and comparison of included studies of CT and MRI liver volumetry were performed. The pooled result was weighted mean difference between estimated and true liver volume. Finally sensitivity and publish bias analysis was performed.Results17 articles with37 studies including351 patients meet the inclusion criteria. There was no heterogeneity among included studies of each group(CT:I2=0%,Q=4.93,P=0.9998; MRI:I2=0%,Q=0.92,P=1). Fixed effect model was selected for the meta-analysis and the weighted mean difference was21.7063 ml〔95% confidence interval (95%CI)=-8.0154 -51.4640 ml)〕 for the CT group and20.9518 ml(95%CI=-60.4360 -102.3395 ml) for the MRI group. There was no statistically significant difference between the true and radiologically estimated whole liver volume of each group(CT:Z=1.4297,P=0.1528; MRI:Z=0.5046,P=0.6139) and between pooled results of each group(Q=0,P=1). Sensitivity analysis revealed the pooled result of each group was robust which was not affected by excluding any of the included studies or changing the effect model. Funnel plot and publish bias analysis revealed no publish bias(CT:t=-1.8820,P=0.0752;MRI:t=0.0015,P=0.9989). Conclusion Accurate liver volumetry could be performed with CT or MRI images. The imaging acquisition methods should be selected according to the patients' general status with respect to the patients' benefits.