Schuijf Joanne D, Bax Jeroen J, Shaw Leslee J, de Roos Albert, Lamb Hildo J, van der Wall Ernst E, Wijns William
Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
Am Heart J. 2006 Feb;151(2):404-11. doi: 10.1016/j.ahj.2005.03.022.
Magnetic resonance imaging (MRI) and multislice computed tomography (MSCT) have emerged as potential noninvasive coronary imaging techniques. The objective of the present study was to clarify the current accuracy of both modalities in the detection of significant coronary artery lesions (compared to conventional angiography as the gold standard) by means of a comprehensive meta-analysis of the presently available literature.
A total of 51 studies on the detection of significant coronary artery stenoses (> or = 50% diameter stenosis) and comparing results with conventional angiography were identified by means of a MEDLINE search. Weighted sensitivities, specificities, and predictive values, all with 95% CIs, as well as summary odds ratios, were calculated for both techniques. In addition, the relationship between diagnostic specificity and disease prevalence was determined using metaregression analysis.
A comparison of sensitivities and specificities revealed significantly higher values for MSCT (weighted average 85% [95% CI 86%-88%] and 95% [95% CI 95%]) as compared with MRI (weighted average 72%, 95% CI 69%-75% and 87%, 95% CI 86%-88%). A significantly higher odds ratio (16.9-fold) for the presence of significant stenosis was observed for MSCT as compared with MRI (6.4-fold) (P < .0001). Linear regression analysis revealed a better specificity for MSCT versus MRI in lower disease prevalence populations (P = .056).
Meta-analysis of the available studies with MRI and MSCT for noninvasive coronary angiography indicates that MSCT has currently a significantly higher accuracy to detect or exclude significant coronary artery disease.
磁共振成像（MRI）和多层螺旋计算机断层扫描（MSCT）已成为潜在的无创冠状动脉成像技术。本研究的目的是通过对现有文献进行全面的荟萃分析，阐明这两种方法在检测显著冠状动脉病变方面（与作为金标准的传统血管造影术相比）目前的准确性。
通过MEDLINE检索，共确定了51项关于检测显著冠状动脉狭窄（直径狭窄≥50%）并与传统血管造影术比较结果的研究。计算了两种技术的加权敏感度、特异度和预测值（均带有95%可信区间）以及汇总比值比。此外，使用元回归分析确定诊断特异度与疾病患病率之间的关系。
敏感度和特异度比较显示，与MRI（加权平均值72%，95%可信区间69%-75%；特异度87%，95%可信区间86%-88%）相比，MSCT的相应值显著更高（加权平均值85%，95%可信区间86%-88%；特异度95%，95%可信区间95%）。与MRI（6.4倍）相比，MSCT检测到显著狭窄的比值比显著更高（16.9倍）（P <.0001）。线性回归分析显示，在疾病患病率较低的人群中，MSCT的特异度优于MRI（P = 0.056）。
对现有使用MRI和MSCT进行无创冠状动脉造影研究的荟萃分析表明，目前MSCT在检测或排除显著冠状动脉疾病方面具有显著更高的准确性。
