三维各向同性与二维常规磁共振关节造影在肩袖撕裂和盂唇病变诊断中的对比：一项荟萃分析。
Comparison between 3D isotropic and 2D conventional MR arthrography for diagnosing rotator cuff tear and labral lesions: A meta-analysis.
机构信息
Department of Emergency Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea.
Department of Radiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Republic of Korea.
出版信息
J Magn Reson Imaging. 2018 Oct;48(4):1034-1045. doi: 10.1002/jmri.26024. Epub 2018 Mar 30.
BACKGROUND
Although 3D-isotropic MR arthrography has been characterized as a substitute imaging tool for rotator cuff tear (RCT) and labral lesions, it has not been commonly used in clinical practice because of controversy related to image blurring and indistinctness of structural edges.
PURPOSE
To perform a comparison of the diagnostic performance of 3D-isotropic MR arthrography and 2D-conventional MR arthrography for diagnosis of RCT (solely RCT, full/partial-thickness supraspinatus [SST]-infraspinatus [IST] tear, or subscapularis [SSc] tear) and labral lesions.
STUDY TYPE
Meta-analysis.
POPULATION
Patients with shoulder pain.
FIELD STRENGTH/SEQUENCE: 3D-isotropic and 2D-conventional MR arthrography at 3.0T or 1.5T.
ASSESSMENT
PubMed and EMBASE were searched following the PRISMA guidelines.
STATISTICAL TESTS
Bivariate modeling and hierarchical summary receiver operating characteristic modeling were performed to compare the overall diagnostic performance of 3D-isotropic and 2D-conventional MR arthrography. Multiple-subgroup analyses were performed for diagnosing RCT, full/partial-thickness SST-IST tear, SSc tear, and labral lesions. Meta-regression analyses were performed according to subject, study, and MR arthrography characteristics including 3D-isotropic sequences (turbo spine echo [TSE] vs. gradient echo [GRE]).
RESULTS
Eleven studies (825 patients) were included. Overall, 3D-isotropic MR arthrography had similar pooled sensitivity (0.90 [95% CI, 0.87-0.93]) (P = 0.95) and specificity (0.92 [95% CI, 0.87-0.95]) (P = 0.99), relative to 2D-conventional MR arthrography (sensitivity, 0.91 [95% CI, 0.86-0.94]); specificity, 0.92 [95% CI, 0.87-0.95]). Multiple-subgroup analyses showed that sensitivities (P = 0.13-0.91) and specificities (P = 0.26-0.99) on 3D-isotropic MR arthrography for diagnosing RCT, full/partial-thickness SST-IST tear, SSC tear, and labral lesions were not significantly different from 2D-conventional MR arthrography. On meta-regression analysis, 3D-TSE sequence demonstrated higher sensitivity (P < 0.01) than 3D-GRE for RCT and labral lesions.
DATA CONCLUSION
3D-isotropic MR arthrography can replace 2D-conventional MR arthrography. 3D-isotropic MR arthrography using TSE sequence is recommended for more accurate diagnosis, as it demonstrates increased sensitivity.
LEVEL OF EVIDENCE
2 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2018;48:1034-1045.
背景
尽管 3D 各向同性磁共振关节造影术已被描述为肩袖撕裂 (RCT) 和盂唇病变的替代成像工具，但由于与图像模糊和结构边缘不清晰相关的争议，它并未在临床实践中广泛应用。
目的
对 3D 各向同性磁共振关节造影术和 2D 常规磁共振关节造影术在诊断 RCT（单纯 RCT、全/部分厚度冈上肌 [SST]-冈下肌 [IST] 撕裂或肩胛下肌 [SSc] 撕裂）和盂唇病变方面的诊断性能进行比较。
研究类型
荟萃分析。
人群
肩部疼痛的患者。
场强/序列：3.0T 或 1.5T 的 3D 各向同性和 2D 常规磁共振关节造影术。
评估
按照 PRISMA 指南对 PubMed 和 EMBASE 进行了搜索。
统计检验
采用双变量模型和分层汇总受试者工作特征模型比较 3D 各向同性和 2D 常规磁共振关节造影术的总体诊断性能。对 RCT、全/部分厚度 SST-IST 撕裂、SSc 撕裂和盂唇病变进行了多项亚组分析。根据对象、研究和磁共振关节造影术特征（包括 3D 各向同性序列（TSE 与 GRE））进行了荟萃回归分析。
结果
共纳入 11 项研究（825 例患者）。总体而言，3D 各向同性磁共振关节造影术的敏感度（0.90 [95%CI，0.87-0.93]）（P = 0.95）和特异度（0.92 [95%CI，0.87-0.95]）（P = 0.99）与 2D 常规磁共振关节造影术相似（敏感度，0.91 [95%CI，0.86-0.94]）；特异度，0.92 [95%CI，0.87-0.95]）。多项亚组分析显示，3D 各向同性磁共振关节造影术在诊断 RCT、全/部分厚度 SST-IST 撕裂、SSc 撕裂和盂唇病变方面的敏感度（P = 0.13-0.91）和特异度（P = 0.26-0.99）与 2D 常规磁共振关节造影术无显著差异。荟萃回归分析显示，3D-TSE 序列在 RCT 和盂唇病变中的敏感度（P < 0.01）高于 3D-GRE。
数据结论
3D 各向同性磁共振关节造影术可替代 2D 常规磁共振关节造影术。建议使用 TSE 序列的 3D 各向同性磁共振关节造影术进行更准确的诊断，因为它可以提高诊断的敏感度。
证据水平
2 技术功效：第 3 阶段 J. Magn. Reson. Imaging 2018;48:1034-1045.
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