用于 Takayasu 动脉炎的诊断和疾病活动评估的影像学方式：一项系统评价和荟萃分析。
Imaging modalities for the diagnosis and disease activity assessment of Takayasu's arteritis: A systematic review and meta-analysis.
机构信息
Division of Rheumatology, Department of Medicine, Department of Microbiology and Immunology, The University of Western Ontario, 268 Grosvenor St., London, Ontario N6H 4V2, Canada.
Division of Rheumatology, Department of Medicine, Department of Microbiology and Immunology, The University of Western Ontario, 268 Grosvenor St., London, Ontario N6H 4V2, Canada.
出版信息
Autoimmun Rev. 2018 Feb;17(2):175-187. doi: 10.1016/j.autrev.2017.11.021. Epub 2017 Dec 5.
BACKGROUND
Early diagnosis of Takayasu's Arteritis (TAK) and detection of disease activity may reduce the risk of vascular complications. The objective of this study was to determine the effectiveness of imaging modalities for the management of TAK.
METHODS
MEDLINE and EMBASE were searched for studies of patients undergoing various imaging modalities for TAK diagnosis or to assess disease activity. We excluded case reports, reviews and case series with <10 patients. The methodologic quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2). Random effects meta-analyses with inverse-variance weighting were performed.
RESULTS
From the 1126 citations screened, 57 studies met our inclusion criteria. Many of the studies were of small sample size (average N=27), cross-sectional design and low methodological quality. Ultrasound (US) had a lower pooled sensitivity (SN) of 81% (95% CI: 69-89%) than Magnetic Resonance Angiography (MRA) with SN=92% (95% CI: 88-95%) for TAK diagnosis (by clinical criteria and/or X-Ray angiography). Both had high specificities (SP) of >90% for TAK diagnosis. Fewer studies investigated computed tomography angiography (CTA), but SN and SP for TAK diagnosis was high (>90%). The utility of vessel wall thickening and enhancement by MRA and CTA to predict disease activity varied across studies. The pooled SN and SP of F-fluorodeoxyglucose-Positron Emission Tomography (FDG-PET) for disease activity was 81% (95% CI: 69-89%) and 74% (95% CI: 55-86%), respectively.
CONCLUSION
US, CTA and/or MRA are effective for the diagnosis of TAK. The utility of these imaging modalities for assessing disease activity remains unclear.
背景
早期诊断 Takayasu 动脉炎（TAK）并检测疾病活动度可能降低血管并发症的风险。本研究旨在确定影像学在 TAK 管理中的作用。
方法
检索 MEDLINE 和 EMBASE 中关于患者接受各种影像学检查以诊断 TAK 或评估疾病活动度的研究。我们排除了病例报告、综述和病例系列，这些研究的病例数<10 例。使用诊断准确性研究质量评估工具 2（QUADAS-2）评估方法学质量。采用逆方差加权的随机效应荟萃分析。
结果
从筛选出的 1126 条引用中，有 57 项研究符合纳入标准。许多研究的样本量较小（平均 N=27），采用横断面设计，方法学质量较低。超声（US）诊断 TAK 的敏感度（SN）为 81%（95% CI：69-89%），低于磁共振血管造影（MRA）的 SN=92%（95% CI：88-95%）（根据临床标准和/或 X 射线血管造影）。两者诊断 TAK 的特异性（SP）均>90%。对计算机断层血管造影（CTA）的研究较少，但 SN 和 SP 用于诊断 TAK 均较高（>90%）。MRA 和 CTA 显示血管壁增厚和强化预测疾病活动度的效用在不同研究中存在差异。FDG-PET 诊断疾病活动度的 SN 和 SP 分别为 81%（95% CI：69-89%）和 74%（95% CI：55-86%）。
结论
US、CTA 和/或 MRA 对 TAK 的诊断有效。这些影像学方法用于评估疾病活动度的效用尚不清楚。
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