Hamon Michèle, Lepage Olivier, Malagutti Patrizia, Riddell John W, Morello Rémy, Agostini Denis, Hamon Martial
Departments of Radiology, University Hospital of Caen, Avenue Côte de Nacre 14033 Caen, Normandy, France.
Radiology. 2008 Jun;247(3):679-86. doi: 10.1148/radiol.2473071132. Epub 2008 Apr 10.
To perform a meta-analysis to evaluate the accuracy of 16- and 64-section spiral computed tomography (CT) to help assess coronary artery bypass grafts (CABGs).
The MEDLINE, Cochrane library, and BioMed Central databases were searched for relevant original articles published up to May 2007. Major criteria for article inclusion were that it (a) used multisection CT as a diagnostic test for the assessment of significant lesions (occlusion or >50% stenosis) of CABG, (b) used a 16- or 64-section scanner, and (c) used coronary angiography as the reference standard. After data extraction, the analysis was performed according to a random-effects model. Between-study statistical heterogeneity was also assessed by using the Cochran Q chi(2) test.
Of 158 screened articles, 15 fulfilled all inclusion criteria. Graft assessability (including distal anastomosis) ranged from 78%-100% among all included studies (mean, 92.4%; 90% with 16- and 96% with 64-section CT; P < .001). Statistical heterogeneity was observed for specificity and positive likelihood ratio (LR), justifying the use of the random-effects model. The analysis, pooled from 15 studies (723 patients, 2023 CABGs), provided the following results for the assessment of graft obstruction (occlusion and >50% stenosis): sensitivity, 97.6% (95% confidence interval [CI]: 96%, 98.6%); specificity, 96.7% (95% CI: 95.6%, 97.5%); positive predictive value, 92.7% (95% CI: 90.5%, 94.6%); negative predictive value, 98.9% (95% CI: 98.2%, 99.4%); positive LR, 23.42 (95% CI: 13.69, 40.07); negative LR, 0.045 (95% CI: 0.028, 0.071); and diagnostic odds ratio, 780.32 (95% CI: 379.12, 1606.1).
Multisection CT provided high accuracy for the evaluation of CABG obstruction in assessable conduits, and might be used as a noninvasive tool for the evaluation of suspected graft dysfunction in patients who are at high risk for complications from coronary angiography.
进行一项荟萃分析，以评估16层和64层螺旋计算机断层扫描（CT）在评估冠状动脉旁路移植术（CABG）方面的准确性。
检索MEDLINE、Cochrane图书馆和BioMed Central数据库，查找截至2007年5月发表的相关原始文章。纳入文章的主要标准为：（a）使用多层CT作为评估CABG显著病变（闭塞或>50%狭窄）的诊断测试；（b）使用16层或64层扫描仪；（c）使用冠状动脉造影作为参考标准。数据提取后，根据随机效应模型进行分析。还使用Cochran Q卡方检验评估研究间的统计异质性。
在158篇筛选文章中，15篇符合所有纳入标准。在所有纳入研究中，移植物可评估性（包括远端吻合口）范围为78% - 100%（平均92.4%；16层CT为90%，64层CT为96%；P <.001）。观察到特异性和阳性似然比（LR）存在统计异质性，这证明使用随机效应模型是合理的。对15项研究（共涉及723例患者和2023个CABG）进行汇总分析，得出评估移植物阻塞（闭塞和>50%狭窄）的结果如下：敏感性为97.6%（95%置信区间[CI]：96%，98.6%）；特异性为96.7%（95% CI：95.6%，97.5%）；阳性预测值为92.7%（95% CI：90.5%，94.6%）；阴性预测值为98.9%（95% CI：98.2%，99.4%）；阳性LR为23.42（95% CI：13.69，40.07）；阴性LR为0.045（95% CI：0.028，0.071）；诊断比值比为780.32（95% CI：379.12，1606.1）。
多层CT在评估可评估管道中的CABG阻塞方面具有较高的准确性，可作为一种非侵入性工具，用于评估冠状动脉造影并发症高风险患者疑似移植物功能障碍的情况。
