荟萃分析：计算机断层扫描与磁共振成像用于非侵入性冠状动脉造影。

Meta-analysis: noninvasive coronary angiography using computed tomography versus magnetic resonance imaging.

机构信息

Department of Radiology, Charité Medical School, Humboldt-Universität zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117 Berlin, Germany.

出版信息

Ann Intern Med. 2010 Feb 2;152(3):167-77. doi: 10.7326/0003-4819-152-3-201002020-00008.

DOI:10.7326/0003-4819-152-3-201002020-00008

PMID:20124233

Abstract

BACKGROUND

Two imaging techniques, multislice computed tomography (CT) and magnetic resonance imaging (MRI), have evolved for noninvasive coronary angiography.

PURPOSE

To compare CT and MRI for ruling out clinically significant coronary artery disease (CAD) in adults with suspected or known CAD.

DATA SOURCES

MEDLINE, EMBASE, and ISI Web of Science searches from inception through 2 June 2009 and bibliographies of reviews.

STUDY SELECTION

Prospective English- or German-language studies that compared CT or MRI with conventional coronary angiography in all patients and included sufficient data for compilation of 2 x 2 tables.

DATA EXTRACTION

2 investigators independently extracted patient and study characteristics; differences were resolved by consensus.

DATA SYNTHESIS

89 and 20 studies (comprising 7516 and 989 patients) assessed CT and MRI, respectively. Bivariate analysis of data yielded a mean sensitivity and specificity of 97.2% (95% CI, 96.2% to 98.0%) and 87.4% (CI, 84.5% to 89.8%) for CT and 87.1% (CI, 83.0% to 90.3%) and 70.3% (CI, 58.8% to 79.7%) for MRI. In studies that included only patients with suspected CAD, sensitivity and specificity of CT were 97.6% (CI, 96.1% to 98.5%) and 89.2% (CI, 86.0% to 91.8%). Covariate analysis yielded a significantly higher sensitivity for CT scanners with more than 16 rows (98.1% [CI, 97.0% to 99.0%]; P < 0.050) than for older-generation scanners (95.6% [CI, 94.0% to 97.0%]). Heart rates less than 60 beats/min during CT yielded significantly better values for sensitivity than did higher heart rates (P < 0.001).

LIMITATIONS

Few studies investigated coronary angiography with MRI. Only 5 studies were direct head-to-head comparisons of CT and MRI. Covariate analyses explained only part of the observed heterogeneity.

CONCLUSION

For ruling out CAD, CT is more accurate than MRI. Scanners with more than 16 rows improve sensitivity, as do slowed heart rates.

PRIMARY FUNDING SOURCE

None.

摘要

背景

两种非侵入性冠状动脉造影成像技术，多层螺旋 CT（CT）和磁共振成像（MRI），已经发展起来。

目的

比较 CT 和 MRI 用于排除疑似或已知冠心病（CAD）成人的临床显著 CAD。

数据来源

从 2009 年 6 月 2 日起通过 MEDLINE、EMBASE 和 ISI Web of Science 搜索，并查阅综述的参考文献。

研究选择

前瞻性英语或德语研究，比较 CT 或 MRI 与所有患者的常规冠状动脉造影，并包含足够的数据以编制 2 x 2 表。

数据提取

2 位研究者独立提取患者和研究特征；差异通过共识解决。

数据综合

分别评估 89 项和 20 项研究（包括 7516 例和 989 例患者）的 CT 和 MRI。对数据进行双变量分析，得出 CT 的平均敏感性和特异性分别为 97.2%（95% CI，96.2%至 98.0%）和 87.4%（CI，84.5%至 89.8%），MRI 为 87.1%（CI，83.0%至 90.3%）和 70.3%（CI，58.8%至 79.7%）。在仅包括疑似 CAD 患者的研究中，CT 的敏感性和特异性分别为 97.6%（CI，96.1%至 98.5%）和 89.2%（CI，86.0%至 91.8%）。协变量分析表明，具有 16 排以上的 CT 扫描仪的敏感性显著更高（98.1%[CI，97.0%至 99.0%]；P<0.050），而较旧一代的扫描仪敏感性较低（95.6%[CI，94.0%至 97.0%]）。CT 时心率低于 60 次/分钟时，敏感性值明显优于高心率（P<0.001）。