中国循证医学杂志

中国循证医学杂志

不同类型和磁场强度心脏磁共振成像诊断冠状动脉疾病准确性的 Meta 分析

查看全文

目的系统评价不同类型和磁场强度心脏磁共振成像(cardiac magnetic resonance,CMR)诊断冠状动脉疾病的准确性。方法计算机检索 PubMed、The Cochrane Library、EMbase、WanFang Data、CNKI 和 CBM 数据库,搜集不同类型和磁场强度 CMR 诊断冠状动脉疾病的研究,检索时限均从建库至 2017 年 5 月 15 日。由 2 名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用 Meta Disc 1.4、RevMan 5.3 和 Stata 12.0 软件进行 Meta 分析,计算合并后的敏感性(Sen)、特异性(Spe)、阳性似然比(+LR)、阴性似然比(–LR)、诊断比值比(DOR)等性能指标,绘制森林图、受试者工作特征曲线(SROC 曲线)并计算 SROC 曲线下面积(AUC)。结果共纳入 20 个诊断性试验,包含 1 357 例患者。Meta 分析结果显示:① 基于患者的 Sen合并、Spe合并、+LR合并、–LR合并、DOR、AUC、验前概率和验后概率分别为[0.87,95%CI(0.82,0.90)]、[0.88,95%CI(0.82,0.92)]、[7.33,95%CI(4.74,11.32)]、[0.15,95%CI(0.11,0.20)]、[49.53,95%CI(27.46,89.36)]、[0.93,95%CI(0.91,0.95)]、20.00% 和 65.00%;② 基于血管的 Sen合并、Spe合并、+LR合并、–LR合并、DOR、AUC、验前概率和验后概率分别为[0.81,95%CI(0.76,0.85)]、[0.87,95%CI(0.81,0.91)]、[6.37,95%CI(4.37,9.30)]、[0.22,95%CI(0.17,0.27)]、[29.58,95%CI(18.53,47.22)]、[0.89,95%CI(0.86,0.92)]、20.00% 和 61.00%;③ 亚组分析结果显示:不同类型 CMR 的 AUROC 间的差异无统计学意义,但 1.5 T 和 3.0 T 强度 CMR 的 AUROC 间的差异有统计学意义。结论当前研究证实 CMR 可作为冠状动脉疾病的诊断方法之一。

ObjectivesTo assess the accuracy of different types and magnetic field intensity of cardiac magnetic resonance for coronary artery disease.MethodsPubMed, The Cochrane Library, EMbase, WanFang Data, CNKI and CBM databases were searched to collect the studies on different types and magnetic field intensity of cardiac magnetic resonance for coronary artery disease from inception to May 15th, 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, data were synthesized by using MetaDisc 1.4, RevMan 5.3 and Stata 12.0 softwares. The pooled sensitivity (Sen), pooled specificity (Spe), pooled positive likelihood ratio (+LR), pooled negative likelihood ratio (–LR), pooled diagnostic odds ratio (DOR) and the area under curve (AUC) of the summary receiver-operating characteristic curve (SROC) were used to assess the diagnostic value of different types and magnetic field intensity of cardiac magnetic resonance.ResultsTwenty diagnostic studies were included, which involved 1 357 patients. The results of meta-analysis showed that (1) based on patient: compared with the gold standard, the pooled Sen, Spe, +LR, –LR, DOR and the AUC of SROC, pre-test probability, post-test probability were (0.87, 95%CI 0.82 to 0.90), (0.88, 95%CI 0.82 to 0.92), (7.33, 95%CI 4.74 to 11.32), (0.15, 95%CI 0.11 to 0.20), (49.53, 95%CI 27.46 to 89.36), (0.93, 95%CI 0.91 to 0.95), 20.00% and 65.00%, respectively. (2) Based on blood vessels: the pooled Sen, Spe, +LR, –LR, DOR and the AUC of SROC, pre-test probability, post-test probability were (0.81, 95%CI 0.76 to 0.85), (0.87, 95%CI 0.81 to 0.91), (6.37, 95%CI 4.37 to 9.30), (0.22, 95%CI 0.17 to 0.27), (29.58, 95%CI 18.53 to 47.22), (0.89, 95%CI 0.86 to 0.92), 20.00% and 61.00%, respectively. (3) Subgroup analysis showed that there was no difference in AUROC of different types of cardiac magnetic resonance, but significant difference was found in AUROC of 1.5T and 3.0T magnetic field intensity.ConclusionsCurrent evidence shows that, compared with gold standard, cardiac magnetic resonance can be regarded as an effective and feasible method for preoperative staging of breast cancer.

关键词: 磁共振血管造影; 冠状动脉疾病; 间接比较; Meta 分析; 诊断性试验

Key words: Cardiac magnetic resonance; Coronary artery disease; Indirect comparison; Meta-analysis; Diagnostic test

引用本文: 邵鸿生, 孙月, 马文娟, 施树珍, 苟铃珠, 雷军强, 田金徽. 不同类型和磁场强度心脏磁共振成像诊断冠状动脉疾病准确性的 Meta 分析. 中国循证医学杂志, 2018, 18(4): 315-325. doi: 10.7507/1672-2531.201708056 复制

登录后 ,请手动点击刷新查看全文内容。 没有账号,
登录后 ,请手动点击刷新查看图表内容。 没有账号,
1. 李锐洁, 李静, 陈玉成, 等. 药物洗脱支架治疗冠状动脉疾病的 Meta 分析. 中国循证医学杂志, 2005, 5(7): 519-535.
2. Go AS, Mozaffarian D, Roger VL, et al. Executive summary: heart disease and stroke statistics-2013 update: a report from the American Heart Association. Circulation, 2013, 127(1): 143-152.
3. 胡大一, 马长生. 心脏病学实践 (2013). 北京: 人民卫生出版社, 2013: 108-123.
4. 毛光品, 黄诚意, 朱劲草, 等. 心脏磁共振多技术扫描在冠状动脉粥样硬化性心脏病心肌缺血诊断与评估预后中的应用价值. 现代实用医学, 2016, 28(5): 571-573.
5. Ohyama Y, Volpe GJ, Lima JA. Subclinical myocardial disease in heart failure detected by CMR. Curr Cardiovasc Imaging Rep, 2014, 7: 9269.
6. Battaglia M, Bucher H, Egger M, et al. The Bayes library of diagnostic studies and reviews, 2nd edition. 2002.
7. Whiting PF, Rutjes AW, Westwood ME, et al. QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med, 2011, 155(8): 529-536.
8. Thiele H, Plein S, Breeuwer M, et al. Color-encoded semiautomatic analysis of multi-slice first-pass magnetic resonance perfusion: comparison to tetrofosmin single photon emission computed tomography perfusion and X-ray angiography. Int J Cardiovasc Imaging, 2004, 20(5): 371-384.
9. Klem I, Heitner JF, Shah DJ, et al. Improved detection of coronary artery disease by stress perfusion cardiovascular magnetic resonance with the use of delayed enhancement infarction imaging. J Am Coll Cardiol, 2006, 47(8): 1630-1638.
10. Cheng LQ, Gao Y, Guaricci AI, et al. Breath-hold 3D steady-state free precession coronary MRA compared with conventional X-ray coronary angiography. J Magn Reson Imaging, 2006, 23(5): 669-673.
11. McCarthy RM, Deshpande VS, Beohar N, et al. Three-dimensional breathhold magnetization-prepared TrueFISP: a pilot study for magnetic resonance imaging of the coronary artery disease. Invest Radiol, 2007, 42(10): 665-670.
12. Cheng AS, Pegg TJ, Karamitsos TD, et al. Cardiovascular magnetic resonance perfusion imaging at 3-tesla for the detection of coronary artery disease: a comparison with 1.5-tesla. J Am Coll Cardiol, 2007, 49(25): 2440-2449.
13. Yang Q, Li K, Liu X, et al. Contrast-enhanced whole-heart coronary magnetic resonance angiography at 3.0-T: a comparative study with X-ray angiography in a single center. J Am Coll Cardiol, 2009, 54(1): 69-76.
14. Kato S, Kitagawa K, Ishida N, et al. Assessment of coronary artery disease using magnetic resonance coronary angiography: a national multicenter trial. J Am Coll Cardiol, 2010, 56(12): 983-991.
15. Wagner M, Rösler R, Lembcke A, et al. Whole-heart coronary magnetic resonance angiography at 1.5 Tesla: does a blood-pool contrast agent improve diagnostic accuracy? Invest Radiol, 2011, 46(3): 152-159.
16. Jogiya R, Kozerke S, Morton G, et al. Validation of dynamic 3-dimensional whole heart magnetic resonance myocardial perfusion imaging against fractional flow reserve for the detection of significant coronary artery disease. J Am Coll Cardiol, 2012, 60(8): 756-765.
17. Bettencourt N, Chiribiri A, Schuster A, et al. Cardiac magnetic resonance myocardial perfusion imaging for detection of functionally significant obstructive coronary artery disease: a prospective study. Int J Cardiol, 2013, 168(2): 765-773.
18. Heer T, Reiter S, Höfling B, et al. Diagnostic performance of non-contrast-enhanced whole-heart magnetic resonance coronary angiography in combination with adenosine stress perfusion cardiac magnetic resonance imaging. Am Heart J, 2013, 166(6): 999-1009.
19. Salerno M, Taylor A, Yang Y, et al. Adenosine stress cardiovascular magnetic resonance with variable-density spiral pulse sequences accurately detects coronary artery disease: initial clinical evaluation. Circ Cardiovasc Imaging, 2014, 7(4): 639-646.
20. Ramos V, Bettencourt N, Silva J, et al. Noninvasive anatomical and functional assessment of coronary artery disease. Rev Port Cardiol, 2015, 34(4): 223-232.
21. Mordi I, Stanton T, Carrick D, et al. Comprehensive dobutamine stress CMR versus echocardiography in LBBB and suspected coronary artery disease. JACC Cardiovasc Imaging, 2014, 7(5): 490-498.
22. 刘劭坤, 田秀峰. 3.0T 磁共振对比增强冠状动脉成像的应用价值探讨. 实用医学影像杂志, 2014, 15(4): 301-302.
23. Ponte M, Bettencourt N, Pereira E, et al. Anatomical versus functional assessment of coronary artery disease: direct comparison of computed tomography coronary angiography and magnetic resonance myocardial perfusion imaging in patients with intermediate pre-test probability. Int J Cardiovasc Imaging, 2014, 30(8): 1589-1597.
24. Greulich S, Steubing H, Birkmeier S, et al. Impact of arrhythmia on diagnostic performance of adenosine stress CMR in patients with suspected or known coronary artery disease. J Cardiovasc Magn Reson, 2015, 17: 94.
25. Namba Y, Fuke S, Kashihara Y, et al. Diagnostic accuracy of three different protocols for 3.0T coronary magnetic resonance angiography. Int Heart J, 2016, 57(5): 535-540.
26. Ripley DP, Nezafat M, Foley JR, et al. Diagnostic accuracy of Dixon water fat suppression coronary artery magnetic resonance angiography at 3.0 Tesla.J Cardiovasc Magn Reson, 2016, 18(Suppl 1): Q11.
27. He Y, Pang J, Dai Q, et al. Diagnostic performance of self-navigated whole-heart contrast-enhanced coronary 3-T MR angiography. Radiology, 2016, 281(2): 401-408.
28. 吴景玲, 葛龙, 张俊华, 等. 多个诊断性试验准确性的比较: 网状 Meta 分析方法介绍. 中国循证医学杂志, 2017, 17(8): 987-992.
29. 田金徽, 陈耀龙, 杨克虎, 等. SR/MA 研究进展与挑战. 兰州大学学报 (医学版), 2016, 42(1): 42-47.