Department of General Surgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China.
Hepatobiliary Pancreat Dis Int. 2009 Oct;8(5):457-64.
Preoperative diagnosis of local vascular invasion is very important to the selection of therapeutic protocols and prediction of the prognosis of pancreatic and periampullary cancers. This meta-analysis was designed to evaluate the accuracy of computed tomography (CT) in diagnosing vascular invasion in patients with pancreatic and periampullary cancers.
English-language articles reporting diagnostic accuracy of CT for vascular invasion in pancreatic and periampullary cancers were searched from the MEDLINE and PubMed databases. A meta-analysis was conducted to estimate pooled sensitivity, specificity, likelihood ratios, and diagnostic odds ratios.
Data were extracted from 18 studies that met the inclusion criteria. The pooled sensitivity and specificity of CT in diagnosing vascular invasion were 77% and 81%. Since CT technology improved in different periods, in the recent five years (2004-2008) CT has shown a higher diagnostic accuracy, and the pooled sensitivity and specificity increased to 85% and 82%, respectively. Subgroup analysis of CT studies was made to determine the involvement of different vessels, and the pooled sensitivities for the invasion of the venous system, portal vein, and arterial system were 75%, 75%, and 68%, and the pooled specificities were 84%, 91%, and 92%, respectively. For CT imaging with vascular reconstruction, the pooled sensitivity and specificity were 84% and 85%, higher than the estimates in studies without reconstruction.
Developed CT technology with vascular reconstruction is used as an imaging modality for diagnosing vascular invasion at present. Further combined application of various imaging modalities may improve the accuracy of diagnosis, especially for smaller vessel involvement, such as the superior mesenteric vein or artery, which are difficult to demarcate.
术前诊断局部血管侵犯对选择治疗方案和预测胰腺和壶腹周围癌的预后非常重要。本荟萃分析旨在评估计算机断层扫描（CT）诊断胰腺和壶腹周围癌血管侵犯的准确性。
从 MEDLINE 和 PubMed 数据库中检索了以英文发表的报告 CT 对胰腺和壶腹周围癌血管侵犯诊断准确性的文章。进行荟萃分析以估计合并敏感性、特异性、似然比和诊断优势比。
从符合纳入标准的 18 项研究中提取数据。CT 诊断血管侵犯的合并敏感性和特异性分别为 77%和 81%。由于 CT 技术在不同时期有所改进，在最近五年（2004-2008 年），CT 的诊断准确性更高，合并敏感性和特异性分别提高到 85%和 82%。对 CT 研究进行了亚组分析，以确定不同血管的受累情况，静脉系统、门静脉和动脉系统侵犯的合并敏感性分别为 75%、75%和 68%，特异性分别为 84%、91%和 92%。对于具有血管重建的 CT 成像，合并敏感性和特异性分别为 84%和 85%，高于无重建研究的估计值。
目前，具有血管重建功能的先进 CT 技术被用作诊断血管侵犯的影像学手段。进一步联合应用多种影像学方法可能会提高诊断准确性，特别是对于较小的血管受累，如肠系膜上静脉或动脉，这些血管难以界定。
