Nederkoorn Paul J, van der Graaf Yolanda, Hunink M G Myriam
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
Stroke. 2003 May;34(5):1324-32. doi: 10.1161/01.STR.0000068367.08991.A2. Epub 2003 Apr 10.
The purpose of this work was to review and compare published data on the diagnostic value of duplex ultrasonography (DUS), MR angiography (MRA), and conventional digital subtraction angiography (DSA) for the diagnosis of carotid artery stenosis.
We performed a systematic review of published studies retrieved through PUBMED, from bibliographies of review papers, and from experts. The English-language medical literature was searched for studies that met the selection criteria: (1) The study was published between 1994 and 2001; (2) MRA and/or DUS was performed to estimate the severity of carotid artery stenosis; (3) DSA was used as the standard of reference; and (4) the absolute numbers of true positives, false negatives, true negatives, and false positives were available or derivable for at least one definition of disease (degree of stenosis).
Sixty-three publications on duplex, MRA, or both were included in the analysis, yielding the test results of 64 different patient series on DUS and 21 on MRA. For the diagnosis of 70% to 99% versus <70% stenosis, MRA had a pooled sensitivity of 95% (95% CI, 92 to 97) and a pooled specificity of 90% (95% CI, 86 to 93). These numbers were 86% (95% CI, 84 to 89) and 87% (95% CI, 84 to 90) for DUS, respectively. For recognizing occlusion, MRA yielded a sensitivity of 98% (95% CI, 94 to 100) and a specificity of 100% (95% CI, 99 to 100), and DUS had a sensitivity of 96% (95% CI, 94 to 98) and a specificity of 100% (95% CI, 99 to 100). A multivariable summary receiver-operating characteristic curve (ROC) analysis for diagnosing 70% to 99% stenosis demonstrated that the type of MR scanner predicted the performance of MRA, whereas the presence of verification bias predicted the performance of DUS. For diagnosing occlusion, no significant heterogeneity was found for MRA; for DUS, the presence of verification bias and type of DUS scanner were explanatory variables. MRA had a significantly better discriminatory power than DUS in diagnosing 70% to 99% stenosis (regression coefficient, 1.6; 95% CI, 0.37 to 2.77). No significant difference was found in detecting occlusion (regression coefficient, 0.73; 95% CI, -2.06 to 3.51).
These results suggest that MRA has a better discriminatory power compared with DUS in diagnosing 70% to 99% stenosis and is a sensitive and specific test compared with DSA in the evaluation of carotid artery stenosis. For detecting occlusion, both DUS and MRA are very accurate.
本研究旨在回顾和比较已发表的关于双功超声（DUS）、磁共振血管造影（MRA）和传统数字减影血管造影（DSA）诊断颈动脉狭窄的价值的数据。
我们对通过PUBMED、综述文章的参考文献以及专家检索到的已发表研究进行了系统评价。检索英文医学文献，查找符合以下选择标准的研究：（1）研究发表于1994年至2001年之间；（2）进行了MRA和/或DUS以评估颈动脉狭窄的严重程度；（3）DSA用作参考标准；（4）至少有一种疾病定义（狭窄程度）的真阳性、假阴性、真阴性和假阳性的绝对数量可用或可推导。
分析纳入了63篇关于双功超声、MRA或两者的出版物，得出了64个不同患者系列的DUS测试结果和21个MRA测试结果。对于诊断70%至99%与<70%的狭窄，MRA的合并敏感性为95%（95%CI，92至97），合并特异性为90%（95%CI，86至93）。DUS的这些数字分别为86%（95%CI，84至89）和87%（95%CI,84至90）。对于识别闭塞，MRA的敏感性为98%（95%CI，94至100），特异性为100%（95%CI，99至100），DUS的敏感性为96%（95%CI，94至98），特异性为100%（95%CI，99至100）。用于诊断70%至99%狭窄的多变量汇总受试者工作特征曲线（ROC）分析表明，MR扫描仪的类型可预测MRA的性能，而验证偏倚的存在可预测DUS的性能。对于诊断闭塞，MRA未发现显著异质性；对于DUS，验证偏倚的存在和DUS扫描仪的类型是解释变量。在诊断70%至99%狭窄方面，MRA的鉴别能力明显优于DUS（回归系数，1.6；95%CI，0.37至2.77）。在检测闭塞方面未发现显著差异（回归系数，0.73；95%CI，-2.06至3.51）。
这些结果表明，在诊断70%至99%狭窄方面，MRA与DUS相比具有更好的鉴别能力，并且在评估颈动脉狭窄方面与DSA相比是一种敏感且特异的检测方法。对于检测闭塞，DUS和MRA都非常准确。
