Tufts University, School of Medicine, Boston, MA, USA.
Osteoarthritis Cartilage. 2012 Jan;20(1):13-21. doi: 10.1016/j.joca.2011.10.003. Epub 2011 Oct 19.
Osteoarthritis (OA) is currently diagnosed using clinical and radiographic findings. In recent years magnetic resonance imaging (MRI) use in OA has increasingly been studied. This study was conducted to determine the diagnostic utility of MRI in OA through a meta-analysis of published studies.
A systematic literature search was undertaken to include studies that used MRI to evaluate or detect OA. MRI was compared to various reference standards: histology, arthroscopy, radiography, CT, clinical evaluation, and direct visual inspection. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and receiver operating characteristic (ROC) area under the curve (AUC) were calculated. Random-effects models were used to pool results.
Of 20 relevant studies identified from the literature, 16 reported complete data and were included in the meta-analysis, with a total of 1220 patients (1071 with OA and 149 without). Overall sensitivity from pooling data of all the included studies was 61% [95% confidence interval (CI) 53-68], specificity was 82% (95% CI 77-87), PPV was 85% (95% CI 80-88), and NPV was 57% (95% CI 43-70). The ROC showed an AUC of 0.804. There was significant heterogeneity in the above parameters (I(2)>83%). With histology as the reference standard, sensitivity increased to 74% and specificity decreased to 76% compared with all reference standards combined. When arthroscopy was used as the reference standard, sensitivity increased to 69% and specificity to 93% compared with all reference standards combined.
MRI can detect OA with an overall high specificity and moderate sensitivity when compared with various reference standards, thus lending more utility to ruling out OA than ruling it in. The sensitivity of MRI is below the current clinical diagnostic standards. At this time standard clinical algorithm for OA diagnosis, aided by radiographs appears to be the most effective method for diagnosing OA.
骨关节炎（OA）目前是通过临床和影像学检查进行诊断的。近年来，磁共振成像（MRI）在 OA 中的应用越来越受到关注。本研究通过对已发表研究的荟萃分析，旨在确定 MRI 在 OA 中的诊断效用。
系统检索文献以纳入使用 MRI 评估或检测 OA 的研究。将 MRI 与各种参考标准（组织学、关节镜、放射学、CT、临床评估和直接目视检查）进行比较。计算了敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）和受试者工作特征（ROC）曲线下面积（AUC）。采用随机效应模型对结果进行汇总。
从文献中确定了 20 项相关研究，其中 16 项研究报告了完整数据并纳入荟萃分析，共纳入 1220 名患者（1071 名 OA 患者和 149 名非 OA 患者）。汇总所有纳入研究数据的总体敏感性为 61%[95%置信区间（CI）53-68%]，特异性为 82%（95% CI 77-87%），PPV 为 85%（95% CI 80-88%），NPV 为 57%（95% CI 43-70%）。ROC 显示 AUC 为 0.804。上述参数存在显著异质性（I²>83%）。与组织学作为参考标准相比，与所有参考标准相结合时，敏感性增加至 74%，特异性降低至 76%。与所有参考标准相结合时，当关节镜作为参考标准时，敏感性增加至 69%，特异性增加至 93%。
与各种参考标准相比，MRI 可以检测 OA，特异性高，敏感性中等，因此在排除 OA 方面比确诊 OA 更具实用性。MRI 的敏感性低于目前的临床诊断标准。目前，辅助 X 线的 OA 诊断标准临床算法似乎是诊断 OA 的最有效方法。
