Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada.
Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada.
J Clin Lipidol. 2019 Jan-Feb;13(1):40-48. doi: 10.1016/j.jacl.2018.10.013. Epub 2018 Nov 7.
Achilles tendon xanthoma (ATX) results from tendon thickening and subclinical inflammation triggered by hypercholesterolemia, and is associated with more severe coronary artery disease and a higher risk of cardiovascular events. The ability to detect ATX by clinical examination is limited, and diagnostic imaging, for instance, using ultrasonography or magnetic resonance imagine (MRI), may improve the identification of ATX. However, the accuracy of ultrasound (US) imaging or MRI in identifying ATX in people with familial hypercholesterolemia (FH) has not been systematically reviewed.
The objective of this study was to systematically review the accuracy of US imaging or MRI in diagnosing ATX in individuals with FH.
Searches in Medline, Embase, Cochrane Central, and Cochrane Database of Systematic Reviews on the Ovid platform from inception to April 15, 2018, were conducted to identify articles. Any study design that included US imaging or MRI of Achilles tendon xanthoma in people with FH, and that included a control group of non-FH participants with either normal or symptomatic Achilles tendons, was considered eligible. All of the included studies were reviewed according to the STAndards for the Reporting of Diagnostic accuracy (STARD) method. A qualitative synthesis of the included studies was undertaken.
Fifteen studies with 699 patients with FH and 868 non-FH participants were included. Among the non-FH participants, 26 individuals had other documented Achilles tendon pathology (trauma or overuse). Evaluation with the STARD checklist suggested that the quality of evidence was low. US imaging and MRI may have acceptable sensitivity in detecting tendon thickening associated with ATX. There is a wide range in the suggested thickness thresholds and in the estimates of diagnostic accuracy.
A small amount of low-quality evidence suggests that ultrasonography or MRI can improve clinicians' accuracy in identifying ATX in people with FH, thereby identifying those with more severe coronary artery disease.
跟腱黄色瘤（ATX）是由肌腱增厚和亚临床炎症引起的，这是由高胆固醇血症引起的，与更严重的冠状动脉疾病和更高的心血管事件风险有关。通过临床检查发现 ATX 的能力有限，而诊断成像（例如，使用超声或磁共振成像（MRI））可能会提高对 ATX 的识别能力。然而，超声（US）成像或 MRI 识别家族性高胆固醇血症（FH）患者中 ATX 的准确性尚未得到系统评价。
本研究旨在系统评价 US 成像或 MRI 诊断 FH 个体 ATX 的准确性。
从 1980 年 1 月至 2018 年 4 月 15 日，在 Medline、Embase、Cochrane 中心和 Cochrane 系统评价数据库的 Ovid 平台上进行了搜索，以确定文章。任何包括 FH 患者的跟腱黄色瘤的 US 成像或 MRI 研究设计，以及包括非 FH 参与者的对照组，这些参与者的跟腱正常或有症状，都被认为是合格的。所有纳入的研究均按照诊断准确性报告标准（STARD）方法进行了审查。对纳入的研究进行了定性综合。
纳入了 15 项研究，共纳入 699 例 FH 患者和 868 例非 FH 参与者。在非 FH 参与者中，26 人有其他已记录的跟腱病变（创伤或过度使用）。根据 STARD 检查表进行评估，提示证据质量较低。US 成像和 MRI 可能具有可接受的检测与 ATX 相关的肌腱增厚的敏感性。建议的厚度阈值和诊断准确性的估计值差异很大。
少量低质量证据表明，超声或 MRI 可以提高临床医生识别 FH 患者 ATX 的准确性，从而识别出那些患有更严重冠状动脉疾病的患者。
