Lu Wei, Zheng Jun, Pan Xu-Dong, Zhang Ming-Duo, Zhu Tie-Yuan, Li Bin, Sun Li-Zhong
1 Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing 100029, China ; 2 Department of Cardiology, 3 Department of Pediatric Heart Center, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China.
J Thorac Dis. 2015 Mar;7(3):252-63. doi: 10.3978/j.issn.2072-1439.2015.01.27.
Several studies have addressed the diagnostic accuracy of cardiac magnetic resonance (CMR) to assess acute cardiac allograft rejection (ACAR) compared with endomyocardial biopsy (EMB). But the methodological heterogeneity limited the clinical application of CMR. Accordingly, we have sought a comprehensive, systematic literature review and meta-analysis for the purpose.
Studies prior to September 1, 2014 identified by Medline/PubMed, EMBASE and Cochrance search and citation tracking were examined by two independent reviewers. A study was included if a CMR was used as a diagnostic test for the detection of ACAR.
Of the seven articles met the inclusion criteria. Only four studies using T2 relaxation time as a CMR parameter could be pooled results, because the number of studies using other parameters was less than three. By using DerSimonian-Laird random effects model, meta-analysis demonstrated a pooled sensitivity of 90% [95% confidence interval (CI), 79% to 97%], a pooled specificity of 83% (95% CI, 78% to 88%), and a pooled diagnostic odds ratio (DOR) of 61.66 (95% CI, 18.09 to 210.10).
CMR seems to have a high sensitivity and moderate specificity in the diagnosis of ACAR. However, as a result of CMR for diagnostic ACAR should be comprehensively considered by physicians and imaging experts in the context of clinical presentations and imaging feature. Further investigations are still required to test different parameters and study condition.
与心内膜心肌活检（EMB）相比，已有多项研究探讨了心脏磁共振成像（CMR）评估急性心脏移植排斥反应（ACAR）的诊断准确性。但方法学的异质性限制了CMR的临床应用。因此，我们为此进行了一项全面、系统的文献综述和荟萃分析。
由两名独立审阅者检查通过Medline/PubMed、EMBASE和Cochrance检索及引文追踪确定的2014年9月1日前的研究。如果将CMR用作检测ACAR的诊断测试，则纳入该研究。
七篇文章符合纳入标准。由于使用其他参数的研究数量少于三项，只有四项将T2弛豫时间用作CMR参数的研究能够汇总结果。通过使用DerSimonian-Laird随机效应模型，荟萃分析显示汇总敏感性为90%[95%置信区间（CI），79%至97%]，汇总特异性为83%（95%CI，78%至88%），汇总诊断比值比（DOR）为61.66（95%CI，18.09至210.10）。
CMR在ACAR诊断中似乎具有较高的敏感性和中等的特异性。然而，由于CMR用于诊断ACAR时，医生和影像专家应结合临床表现和影像特征进行综合考虑。仍需要进一步研究来测试不同参数和研究条件。
