Department of Obstetrics and Gynecology, University of Cagliari, Policlinico Universitario Duilio Casula, Monserrato, Cagliari, Italy.
Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), Monserrato, Italy.
Ultrasound Obstet Gynecol. 2018 May;51(5):586-595. doi: 10.1002/uog.18961.
To perform a systematic review of studies comparing the accuracy of transvaginal ultrasound (TVS) and magnetic resonance imaging (MRI) in diagnosing deep infiltrating endometriosis (DIE) including only studies in which patients underwent both techniques.
An extensive search was carried out in PubMed/MEDLINE and Web of Science for papers from January 1989 to October 2016 comparing TVS and MRI in DIE. Studies were considered eligible for inclusion if they reported on the use of TVS and MRI in the same set of patients for the preoperative detection of endometriosis in pelvic locations in women with clinical suspicion of DIE and using surgical data as a reference standard. Quality was assessed using the QUADAS-2 tool. A random-effects model was used to determine pooled sensitivity, specificity, positive and negative likelihood ratios (LR+ and LR-) and diagnostic odds ratio (DOR).
Of 375 citations identified, six studies (n = 424) were considered eligible. For MRI in the detection of DIE in the rectosigmoid, pooled sensitivity was 0.85 (95% CI, 0.78-0.90), specificity was 0.95 (95% CI, 0.83-0.99), LR+ was 18.4 (95% CI, 4.7-72.4), LR- was 0.16 (95% CI, 0.11-0.24) and DOR was 116 (95% CI, 23-585). For TVS in the detection of DIE in the rectosigmoid, pooled sensitivity was 0.85 (95% CI, 0.68-0.94), specificity was 0.96 (95% CI, 0.85-0.99), LR+ was 20.4 (95% CI, 4.7-88.5), LR- was 0.16 (95% CI, 0.07-0.38) and DOR was 127 (95% CI, 14-1126). For MRI in the detection of DIE in the rectovaginal septum, pooled sensitivity was 0.66 (95% CI, 0.51-0.79), specificity was 0.97 (95% CI, 0.89-0.99), LR+ was 22.5 (95% CI, 6.7-76.2), LR- was 0.38 (95% CI, 0.23-0.52) and DOR was 65 (95% CI, 21-204). For TVS in the detection of DIE in the rectovaginal septum, pooled sensitivity was 0.59 (95% CI, 0.26-0.86), specificity was 0.97 (95% CI, 0.94-0.99), LR+ was 23.5 (95% CI, 9.1-60.5), LR- was 0.42 (95% CI, 0.18-0.97) and DOR was 56 (95% CI, 11-275). For MRI in the detection of DIE in the uterosacral ligaments, pooled sensitivity was 0.70 (95% CI, 0.55-0.82), specificity was 0.93 (95% CI, 0.87-0.97), LR+ was 10.4 (95% CI, 5.1-21.2), LR- was 0.32 (95% CI, 0.20-0.51) and DOR was 32 (95% CI, 12-85). For TVS in the detection of DIE in the uterosacral ligaments, pooled sensitivity was 0.67 (95% CI, 0.55-0.77), specificity was 0.86 (95% CI, 0.73-0.93), LR+ was 4.8 (95% CI, 2.6-9.0), LR- was 0.38 (95% CI, 0.29-0.50) and DOR was 12 (95% CI, 7-24). Confidence intervals of pooled sensitivities, specificities and DOR were wide for both techniques in all the locations considered. Heterogeneity was moderate or high for sensitivity and specificity for both TVS and MRI in most locations assessed. According to QUADAS-2, the quality of the included studies was considered good for most domains.
The diagnostic performance of TVS and MRI is similar for detecting DIE involving rectosigmoid, uterosacral ligaments and rectovaginal septum. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
系统评价比较经阴道超声（TVS）和磁共振成像（MRI）诊断深部浸润性子宫内膜异位症（DIE）的准确性的研究，纳入仅在患者接受这两种方法的情况下进行的研究。
在 PubMed/MEDLINE 和 Web of Science 中检索了 1989 年 1 月至 2016 年 10 月间比较 TVS 和 MRI 在 DIE 中的应用的文献。如果研究报告了 TVS 和 MRI 在同一组患者中用于术前检测疑似 DIE 患者盆腔部位的子宫内膜异位症，并使用手术数据作为参考标准，则研究被认为符合纳入标准。使用 QUADAS-2 工具评估质量。使用随机效应模型确定汇总敏感性、特异性、阳性和阴性似然比（LR+和 LR-）以及诊断优势比（DOR）。
在 375 条引用中，有 6 项研究（n=424）符合纳入标准。对于 MRI 在直肠乙状结肠的 DIE 检测，汇总敏感性为 0.85（95%CI，0.78-0.90），特异性为 0.95（95%CI，0.83-0.99），LR+为 18.4（95%CI，4.7-72.4），LR-为 0.16（95%CI，0.11-0.24），DOR 为 116（95%CI，23-585）。对于 TVS 在直肠乙状结肠的 DIE 检测，汇总敏感性为 0.85（95%CI，0.68-0.94），特异性为 0.96（95%CI，0.85-0.99），LR+为 20.4（95%CI，4.7-88.5），LR-为 0.16（95%CI，0.07-0.38），DOR 为 127（95%CI，14-1126）。对于 MRI 在直肠阴道隔的 DIE 检测，汇总敏感性为 0.66（95%CI，0.51-0.79），特异性为 0.97（95%CI，0.89-0.99），LR+为 22.5（95%CI，6.7-76.2），LR-为 0.38（95%CI，0.23-0.52），DOR 为 65（95%CI，21-204）。对于 TVS 在直肠阴道隔的 DIE 检测，汇总敏感性为 0.59（95%CI，0.26-0.86），特异性为 0.97（95%CI，0.94-0.99），LR+为 23.5（95%CI，9.1-60.5），LR-为 0.42（95%CI，0.18-0.97），DOR 为 56（95%CI，11-275）。对于 MRI 在子宫骶韧带的 DIE 检测，汇总敏感性为 0.70（95%CI，0.55-0.82），特异性为 0.93（95%CI，0.87-0.97），LR+为 10.4（95%CI，5.1-21.2），LR-为 0.32（95%CI，0.20-0.51），DOR 为 32（95%CI，12-85）。对于 TVS 在子宫骶韧带的 DIE 检测，汇总敏感性为 0.67（95%CI，0.55-0.77），特异性为 0.86（95%CI，0.73-0.93），LR+为 4.8（95%CI，2.6-9.0），LR-为 0.38（95%CI，0.29-0.50），DOR 为 12（95%CI，7-24）。两种技术在所有考虑的部位的汇总敏感性、特异性和 DOR 的置信区间均较宽。对于大多数评估的部位，TVS 和 MRI 的敏感性和特异性的异质性较高或中度。根据 QUADAS-2，纳入研究的质量在大多数领域被认为是良好的。
TVS 和 MRI 在检测累及直肠乙状结肠、子宫骶韧带和直肠阴道隔的 DIE 方面的诊断性能相似。版权所有©2017 ISUOG。由 John Wiley & Sons Ltd 出版。
