系统评价与荟萃分析：磁共振肠道成像与计算机断层肠道成像在评估小肠克罗恩病疾病活动度中的比较。

Systematic review with meta-analysis: magnetic resonance enterography vs. computed tomography enterography for evaluating disease activity in small bowel Crohn's disease.

机构信息

Department of Gastroenterology, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.

出版信息

Aliment Pharmacol Ther. 2014 Jul;40(2):134-46. doi: 10.1111/apt.12815. Epub 2014 Jun 9.

DOI:10.1111/apt.12815

PMID:24912799

Abstract

BACKGROUND

Magnetic resonance enterography (MRE) has been proposed as a non-ionising alternative method to computed tomography enterography (CTE). Some studies have directly compared CTE and MRE in patients with small bowel Crohn's disease (CD) with variable results.

AIM

To compare the overall diagnostic accuracy in assessing the activity of small bowel and complications.

METHODS

MEDLINE, EMBASE and Cochrane databases were searched for studies on the accuracy of MRE and CTE, as compared with a pre-defined reference standard. Pooled sensitivity, specificity, the weighted area under the curve (AUC), incremental yield (IY) and other diagnostic indices were evaluated.

RESULTS

A total of 290 CD patients from six different studies were analysed. The pooled sensitivity and specificity for MRE in detecting active small bowel CD was 87.9% [95% confidence interval (CI), 81.8-92.5] and 81.2% (95% CI: 71.9-88.4) respectively. The AUC under the summary receiver-operating characteristic (sROC) of MRE was 0.905 (SEM 0.03, standard error of the mean). Likewise, the pooled sensitivity and specificity of CTE in detecting active small bowel CD was 85.8% (95% CI: 79.2-90.9) and 83.6% (95% CI: 75.3-90.1) with the AUC of 0.898. The AUC of MRE in detecting fistula, stenosis and abscess was 0.936, 0.931 and 0.996, respectively, compared to 0.963, 0.616 and 0.899 of CTE. No statistically significant IY for MRE vs. CTE was found (fixed model, P > 0.05).

CONCLUSIONS

Magnetic resonance enterography has a diagnostic effectiveness comparable to computed tomography enterography, thus may serve as a radiation-free alternative for evaluation of patients with Crohn's disease.

摘要

背景

磁共振肠造影术（MRE）已被提议作为一种非电离替代方法，用于计算机断层肠造影术（CTE）。一些研究直接比较了患有小肠克罗恩病（CD）的患者的 CTE 和 MRE，结果各不相同。

目的

比较评估小肠活动和并发症的整体诊断准确性。

方法

在 MEDLINE、EMBASE 和 Cochrane 数据库中搜索关于 MRE 和 CTE 准确性的研究，与预先定义的参考标准进行比较。评估了汇总敏感性、特异性、加权曲线下面积（AUC）、增量收益（IY）和其他诊断指标。

结果

共分析了来自六个不同研究的 290 名 CD 患者。MRE 检测活动性小肠 CD 的汇总敏感性和特异性分别为 87.9%（95%CI，81.8-92.5）和 81.2%（95%CI：71.9-88.4）。MRE 的汇总接收者操作特征（sROC）下的 AUC 为 0.905（SEM 0.03，均值标准误差）。同样，CTE 检测活动性小肠 CD 的汇总敏感性和特异性分别为 85.8%（95%CI：79.2-90.9）和 83.6%（95%CI：75.3-90.1），AUC 为 0.898。MRE 在检测瘘管、狭窄和脓肿方面的 AUC 分别为 0.936、0.931 和 0.996，而 CTE 的 AUC 分别为 0.963、0.616 和 0.899。MRE 与 CTE 相比，IY 没有统计学意义（固定模型，P > 0.05）。