University Hospital and Evangelisches Krankenhaus, Goettingen, Germany.
Ann Intern Med. 2010 Sep 7;153(5):325-34. doi: 10.7326/0003-4819-153-5-201009070-00007.
Contrast-enhanced magnetic resonance angiography (MRA) is a noninvasive, radiation-free imaging method for studying peripheral arterial disease (PAD) of the lower extremities.
To summarize evidence of prospective studies about how well MRA identifies or excludes arterial steno-occlusions (50% to 100% lumen reduction) in adults with PAD symptoms.
PubMed and 3 other databases were searched from 1998 to 2009 without language restrictions.
Two independent reviewers selected 32 studies that compared MRA with intra-arterial digital subtraction angiography in PAD. Eligible studies were prospective and provided data to reconstruct 2 x 2 or 3 x 3 contingency tables (<50% stenosis vs. > or =50% stenosis or occlusion of arterial segments) in at least 10 patients with PAD symptoms.
Two reviewers independently assessed the study quality and extracted the study data, with disagreements resolved by consensus.
The 32 included studies generally had high methodological quality. About 26% of the 1022 included patients had critical limb ischemia with pain at rest or tissue loss. Overall, the pooled sensitivity of MRA was 94.7% (95% CI, 92.1% to 96.4%) and the specificity was 95.6% (CI, 94.0% to 96.8%) for diagnosing segmental steno-occlusions. The pooled positive and negative likelihood ratios were 21.56 (CI, 15.70 to 29.69) and 0.056 (CI, 0.037 to 0.083), respectively. Magnetic resonance angiography correctly classified 95.3%, overstaged 3.1%, and understaged 1.6% of arterial segments.
Similar to most studies of computed tomographic angiography in PAD, the primary studies reported the diagnostic accuracy of MRA on a per-segment basis, not a per-patient basis.
This meta-analysis of 32 prospective studies further increases the evidence that contrast-enhanced MRA has high accuracy for identifying or excluding clinically relevant arterial steno-occlusions in adults with PAD symptoms.
None.
对比增强磁共振血管造影（MRA）是一种用于研究下肢周围动脉疾病（PAD）的非侵入性、无辐射的成像方法。
总结关于 MRA 对有 PAD 症状的成人动脉狭窄闭塞（50%至 100%管腔狭窄）的识别或排除能力的前瞻性研究证据。
从 1998 年至 2009 年，在没有语言限制的情况下，对 PubMed 和其他 3 个数据库进行了检索。
两名独立的审查员选择了 32 项研究，这些研究将 MRA 与 PAD 中的动脉内数字减影血管造影进行了比较。合格的研究是前瞻性的，并为至少 10 名有 PAD 症状的患者提供了数据，以重建 2 x 2 或 3 x 3 列联表（<50%狭窄与≥50%狭窄或闭塞的动脉节段）。
两名审查员独立评估了研究质量并提取了研究数据，有分歧的地方通过共识解决。
32 项纳入的研究总体具有较高的方法学质量。大约 26%的 1022 名纳入患者有静息时疼痛或组织缺失的严重肢体缺血。总体而言，MRA 诊断节段性狭窄闭塞的敏感性为 94.7%（95%CI，92.1%至 96.4%），特异性为 95.6%（CI，94.0%至 96.8%）。阳性和阴性似然比分别为 21.56（CI，15.70 至 29.69）和 0.056（CI，0.037 至 0.083）。MRA 正确分类了 95.3%的动脉节段，高估了 3.1%，低估了 1.6%。
与 PAD 中计算机断层血管造影的大多数研究一样，主要研究报告了 MRA 的诊断准确性是基于每个节段，而不是基于每个患者。
这是对 32 项前瞻性研究的荟萃分析，进一步增加了证据表明，对比增强 MRA 对有 PAD 症状的成人识别或排除临床相关动脉狭窄闭塞具有很高的准确性。
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