Lamb Christopher R, Nelson Justin R
Department of Clinical Sciences and Services, The Royal Veterinary College, University of London, Hertfordshire AL9 7TA, UK.
Vet Radiol Ultrasound. 2015 May-Jun;56(3):231-44. doi: 10.1111/vru.12217. Epub 2014 Oct 22.
A systematic review of diagnostic tests based on radiologic measurements of structures in dogs and cats was done in order to reach generalizable conclusions about the value of making such measurements. Literature search was done using the ISI Web of Knowledge(SM) for studies in the subject category Veterinary sciences. Studies were eligible for inclusion that employed length, angle, area or volume measurements from radiographic, ultrasonographic, CT or MR images of dogs or cats as a diagnostic test for a naturally occurring condition, compared the results of imaging with a reference standard, included at least 10 subjects, and sufficient data that a 2 × 2 table of results could be constructed. Quality of studies was assessed using the QUADAS-2 tool. Twenty-six studies were found describing 40 tests that satisfied the inclusion criteria. Tests were radiographic in 22 (55%) instances and ultrasonographic in 18 (45%). Quality of studies was generally low, with a risk of bias in patient selection in 92% studies, performance of the index test in 73% studies, and patient flow in 42% studies. Median (range) number of subjects was 64 (20-305), sensitivity was 77% (38-99%), specificity was 82% (50-99%), positive likelihood ratio was 4.1 (1-103), and negative likelihood ratio was 0.29 (0.01-1). Two studies that compared accuracy of radiographic measurements to subjective image interpretation alone found no difference. Evidence is weak that radiologic measurements of structures in dogs and cats are useful for diagnosis, hence measurements should not be emphasized as a basis for diagnosis in either teaching or clinical imaging reports.
为了就进行此类测量的价值得出可推广的结论，对基于犬猫结构放射学测量的诊断测试进行了系统评价。使用科学网（ISI Web of Knowledge）（SM）在兽医科学主题类别中检索文献。纳入的研究需满足以下条件：采用犬或猫的X线、超声、CT或MR图像的长度、角度、面积或体积测量作为自然发生疾病的诊断测试；将成像结果与参考标准进行比较；至少纳入10例受试者；有足够的数据以构建结果的2×2表。使用QUADAS-2工具评估研究质量。共发现26项研究，描述了40项符合纳入标准的测试。其中22项（55%）测试为X线检查，18项（45%）为超声检查。研究质量普遍较低，92%的研究在患者选择方面存在偏倚风险，73%的研究在指标测试的实施方面存在偏倚风险，42%的研究在患者流程方面存在偏倚风险。受试者数量中位数（范围）为64（20 - 305），灵敏度为77%（38 - 99%），特异度为82%（50 - 99%），阳性似然比为4.1（1 - 103），阴性似然比为0.29（0.01 - 1）。两项仅比较X线测量准确性与主观图像解读的研究未发现差异。犬猫结构的放射学测量对诊断有用的证据不足，因此在教学或临床影像报告中，不应强调将测量作为诊断依据。
