Doria Andrea S, Moineddin Rahim, Kellenberger Christian J, Epelman Monica, Beyene Joseph, Schuh Suzanne, Babyn Paul S, Dick Paul T
Departments of Diagnostic Imaging, Population Health Sciences, and Paediatrics, the Hospital for Sick Children, Toronto, ON, Canada.
Radiology. 2006 Oct;241(1):83-94. doi: 10.1148/radiol.2411050913. Epub 2006 Aug 23.
To perform a meta-analysis to evaluate the diagnostic performance of ultrasonography (US) and computed tomography (CT) for the diagnosis of appendicitis in pediatric and adult populations.
Medical literature (from 1986 to 2004) was searched for articles on studies that used US, CT, or both as diagnostic tests for appendicitis in children (26 studies, 9356 patients) or adults (31 studies, 4341 patients). Prospective and retrospective studies were included if they separately reported the rate of true-positive, true-negative, false-positive, and false-negative diagnoses of appendicitis from US and CT findings compared with the positive and negative rates of appendicitis at surgery or follow-up. Clinical variables, technical factors, and test performance were extracted. Three readers assessed the quality of studies.
Pooled sensitivity and specificity for diagnosis of appendicitis in children were 88% (95% confidence interval [CI]: 86%, 90%) and 94% (95% CI: 92%, 95%), respectively, for US studies and 94% (95% CI: 92%, 97%) and 95% (95% CI: 94%, 97%), respectively, for CT studies. Pooled sensitivity and specificity for diagnosis in adults were 83% (95% CI: 78%, 87%) and 93% (95% CI: 90%, 96%), respectively, for US studies and 94% (95% CI: 92%, 95%) and 94% (95% CI: 94%, 96%), respectively, for CT studies.
From the diagnostic performance perspective, CT had a significantly higher sensitivity than did US in studies of children and adults; from the safety perspective, however, one should consider the radiation associated with CT, especially in children.
进行一项荟萃分析，以评估超声（US）和计算机断层扫描（CT）对儿童和成人阑尾炎的诊断性能。
检索1986年至2004年的医学文献，查找有关使用US、CT或两者作为儿童（26项研究，9356例患者）或成人（31项研究，4341例患者）阑尾炎诊断测试的研究文章。如果前瞻性和回顾性研究分别报告了根据US和CT检查结果得出的阑尾炎真阳性、真阴性、假阳性和假阴性诊断率，并与手术或随访时阑尾炎的阳性和阴性率进行比较，则纳入研究。提取临床变量、技术因素和测试性能。三位读者评估研究质量。
对于儿童阑尾炎诊断，US研究的合并敏感度和特异度分别为88%（95%置信区间[CI]：86%，90%）和94%（95%CI：92%，95%），CT研究分别为94%（95%CI：92%，97%）和95%（95%CI：94%，97%）。对于成人阑尾炎诊断，US研究的合并敏感度和特异度分别为83%（95%CI：78%，87%）和93%（95%CI：90%，96%），CT研究分别为94%（95%CI：92%，95%）和94%（95%CI：94%，96%）。
从诊断性能角度来看，在儿童和成人研究中，CT的敏感度显著高于US；然而，从安全性角度考虑，应考虑CT相关的辐射，尤其是在儿童中。
