Jiang B, Wang J, Lv X, Cai W
Department of Radiology, BenQ Medical Center, Nanjing Medical University, 71 Hexi Street, Jianye District, Nanjing 210019, China.
Department of Radiology, BenQ Medical Center, Nanjing Medical University, 71 Hexi Street, Jianye District, Nanjing 210019, China.
Clin Radiol. 2014 Aug;69(8):861-9. doi: 10.1016/j.crad.2014.03.023. Epub 2014 May 20.
To perform a meta-analysis to compare the diagnostic performance of single-source 64-section computed tomography (CT) versus dual-source CT angiography for diagnosis of coronary artery disease (CAD).
The Cochrane Library, MEDLINE, and EMBASE were searched for relevant original papers. Inclusion criteria were (1) significant CAD defined as ≥50% reduction in luminal diameter by invasive coronary angiography as reference standard; (2) single-source 64-section CT or dual-source CT was used; (3) results were reported in absolute numbers of true-positive, false-positive, true-negative, and false-negative results or sufficiently detailed data for deriving these numbers were presented. A random-effects model was used for the meta-analysis.
Fifty-one papers including 3966 patients who underwent single-source 64-section CT and 2047 patients who underwent dual-source CT at a per-patient level were pooled. The diagnostic values of single-source 64-section CT versus dual-source CT were 97% versus 97% for sensitivity (p = 0.386), 78% versus 86% for specificity (p < 0.001), 90% versus 85% for positive predictive value (PPV; p < 0.001), 93% versus 97% for negative predictive value (NPV; p = 0.001), 6.8 versus 6.5 for positive likelihood ratio (p = 0.018), 0.04 versus 0.04 for negative likelihood ratio (p = 0.625), and 191.59 versus 207.37 for diagnostic odds ratio (p = 0.043), respectively.
Dual-source CT and single-source 64-section CT have similar negative likelihood ratios and, therefore, there was no significant difference in their utility to rule out CAD in intermediate-risk patients. However, compared to single-source 64-section CT, dual-source CT has significantly higher specificity, so that CT-based decisions for subsequent coronary catheter angiography are more accurate.
进行一项荟萃分析，比较单源64层计算机断层扫描（CT）与双源CT血管造影术对冠状动脉疾病（CAD）的诊断性能。
检索Cochrane图书馆、MEDLINE和EMBASE以查找相关原始论文。纳入标准为：（1）以有创冠状动脉造影为参考标准，将显著CAD定义为管腔直径减少≥50%；（2）使用单源64层CT或双源CT；（3）结果以真阳性、假阳性、真阴性和假阴性结果的绝对数报告，或提供了用于得出这些数字的足够详细的数据。荟萃分析采用随机效应模型。
汇总了51篇论文，其中包括3966例接受单源64层CT检查的患者和2047例在个体水平上接受双源CT检查的患者。单源64层CT与双源CT的诊断价值分别为：灵敏度97%对97%（p = 0.386），特异度78%对86%（p < 0.001），阳性预测值（PPV）90%对85%（p < 0.001），阴性预测值（NPV）93%对97%（p = 0.001），阳性似然比6.8对6.5（p = 0.018），阴性似然比0.04对0.04（p = 0.625），诊断比值比191.59对207.37（p = 0.043）。
双源CT和单源64层CT具有相似的阴性似然比，因此，它们在排除中度风险患者CAD方面的效用没有显著差异。然而，与单源64层CT相比，双源CT具有显著更高的特异度，因此基于CT的后续冠状动脉导管造影决策更准确。
