Romagnuolo Joseph, Bardou Marc, Rahme Elham, Joseph Lawrence, Reinhold Caroline, Barkun Alan N
University of Calgary, Calgary, Alberta, Canada.
Ann Intern Med. 2003 Oct 7;139(7):547-57. doi: 10.7326/0003-4819-139-7-200310070-00006.
Magnetic resonance cholangiopancreatography (MRCP) is one of many newer noninvasive tests that can image the biliary tree.
To precisely estimate the overall sensitivity and specificity of MRCP in suspected biliary obstruction and to evaluate clinically important subgroups.
MEDLINE search (January 1987 to March 2003) for studies in English or French, bibliographies, and subject matter experts.
Studies were included if they allowed construction of 2x2 contingency tables of MRCP compared with a reasonable gold standard for at least 1 of the following: the presence, level, or cause of biliary obstruction.
Two independent observers graded study quality, which included consecutive enrollment, blinding, use of a single (versus composite) gold standard, and nonselective use of the gold standard. Logistic regression was used to examine the influence of publication year, quality score, proportion of patients having a "direct" gold standard, and clinical context on diagnostic performance.
Of 498 studies identified, 67 were included (4711 patients). Mixed-effect models were used to estimate the sensitivity and specificity, and quantitative receiver-operating characteristic analysis was performed. Magnetic resonance cholangiopancreatography had a high overall pooled sensitivity (95% [+/-1.96 SD: spread of SD, 75% to 99%]) and specificity (97% [spread of SD, 86% to 99%]). The procedure was less sensitive for stones (92%; odds ratio, 0.51 [CI, 0.35 to 0.75]) and malignant conditions (88%; odds ratio, 0.28 [CI, 0.18 to 0.44]) than for the presence of obstruction. In addition, diagnostic performance was higher in studies that were larger, did not use consecutive enrollment, and did not use gold standard assessment for some patients.
Magentic resonance cholangiopancreatography is a noninvasive imaging test with excellent overall sensitivity and specificity for demonstrating the level and presence of biliary obstruction; however, it seems less sensitive for detecting stones or differentiating malignant from benign obstruction.
磁共振胰胆管造影（MRCP）是众多可对胆管树成像的新型无创检查之一。
精确估计MRCP在疑似胆管梗阻中的总体敏感性和特异性，并评估具有临床重要意义的亚组。
检索MEDLINE（1987年1月至2003年3月）中英语或法语研究、参考文献以及主题专家。
若研究允许构建MRCP与以下至少一项合理金标准的2×2列联表，则纳入研究：胆管梗阻的存在、部位或病因。
两名独立观察者对研究质量进行评分，包括连续入组、盲法、使用单一（而非综合）金标准以及对金标准的非选择性使用。采用逻辑回归分析来检验发表年份、质量评分、具有“直接”金标准的患者比例以及临床背景对诊断性能的影响。
在498项识别出的研究中，纳入了67项（4711例患者）。采用混合效应模型估计敏感性和特异性，并进行定量接受者操作特征分析。磁共振胰胆管造影总体合并敏感性较高（95%[±1.96标准差：标准差范围，75%至99%]），特异性较高（97%[标准差范围，86%至99%]）。该检查对结石（92%；比值比，0.51[可信区间，0.35至0.75]）和恶性疾病（88%；比值比，0.28[可信区间，0.18至0.44]）的敏感性低于对梗阻存在情况的敏感性。此外，在规模较大、未采用连续入组且未对部分患者进行金标准评估的研究中，诊断性能更高。
磁共振胰胆管造影是一种无创成像检查，对显示胆管梗阻的部位和存在情况具有出色的总体敏感性和特异性；然而，其在检测结石或区分恶性与良性梗阻方面似乎敏感性较低。
