下肢动脉疾病：多排CT血管造影荟萃分析

Lower extremity arterial disease: multidetector CT angiography meta-analysis.

作者信息

Heijenbrok-Kal Majanka H, Kock Marc C J M, Hunink M G Myriam

机构信息

Program for the Assessment of Radiological Technology, Department of Epidemiology, Erasmus MC-University Medical Center Rotterdam, Dr Molewaterplein 50, Room H Ee 2140b, 3015 GD, Rotterdam, The Netherlands.

出版信息

Radiology. 2007 Nov;245(2):433-9. doi: 10.1148/radiol.2451061280. Epub 2007 Sep 11.

DOI:10.1148/radiol.2451061280

PMID:17848679

Abstract

PURPOSE

To obtain the best available estimates of the diagnostic performance of multidetector computed tomographic (CT) angiography compared with that of digital subtraction angiography (DSA) in the assessment of symptomatic lower extremity arterial disease and to identify the most important sources of variation in diagnostic performance between studies.

MATERIALS AND METHODS

Reports of studies published from January 2000 through April 2006 in English, German, French, or Spanish were searched for by using the MEDLINE, EMBASE, and Cochrane databases. Studies were included if they allowed construction of 2 x 2 contingency tables for the detection of stenosis of 50% or greater at multidetector CT angiography compared with that at DSA -- the reference standard -- in patients with claudication or critical ischemia. Two observers extracted data about study design, patient characteristics, arterial tracts, and technical protocols. Random-effects summary receiver operating characteristic analysis was performed to examine the influence of these data on diagnostic performance.

RESULTS

Of the 70 studies initially identified, 12 were included in which multidetector CT angiography was used to evaluate 9541 arterial segments in 436 patients. The pooled sensitivity and specificity for detecting a stenosis of at least 50% per segment were 92% (95% confidence interval: 89%, 95%) and 93% (95% confidence interval: 91%, 95%), respectively. Three studies provided data about the diagnostic performance of multidetector CT angiography in subdivisions of the arterial tract. The diagnostic performance of multidetector CT angiography in the infrapopliteal tract was lower than but not significantly different from that in the aortoiliac (P > .11) and femoropopliteal (P > .40) tracts. Regression analysis showed that diagnostic performance was not significantly influenced by differences in study characteristics.

CONCLUSION

Multidetector CT angiography is an accurate diagnostic test in the assessment of arterial disease (> or =50% stenosis) of the entire lower extremity.

摘要

目的

获取多排螺旋计算机断层扫描（CT）血管造影与数字减影血管造影（DSA）在评估有症状的下肢动脉疾病时诊断性能的最佳可用估计值，并确定研究之间诊断性能差异的最重要来源。

材料与方法

通过使用MEDLINE、EMBASE和Cochrane数据库检索2000年1月至2006年4月以英文、德文、法文或西班牙文发表的研究报告。如果研究允许构建2×2列联表，以比较多排螺旋CT血管造影与作为参考标准的DSA在检测跛行或严重缺血患者中50%或更高程度狭窄方面的情况，则纳入该研究。两名观察者提取了有关研究设计、患者特征、动脉段和技术方案的数据。进行随机效应汇总接受者操作特征分析，以检查这些数据对诊断性能的影响。

结果

在最初确定的70项研究中，有12项被纳入，其中多排螺旋CT血管造影用于评估436例患者的9541个动脉段。检测每段至少50%狭窄的合并敏感性和特异性分别为92%（95%置信区间：89%，95%）和93%（95%置信区间：91%，95%）。三项研究提供了多排螺旋CT血管造影在动脉段亚组中诊断性能的数据。多排螺旋CT血管造影在腘下动脉段的诊断性能低于主动脉髂动脉段（P>.11）和股腘动脉段（P>.40），但差异无统计学意义。回归分析表明，研究特征的差异对诊断性能没有显著影响。