Yiyi Ma, Xiaoqin Qian, Lei Zhang
Department of Ultrasound, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu Province, 214000, China.
Iran J Public Health. 2022 Sep;51(9):1925-1935. doi: 10.18502/ijph.v51i9.10548.
Chronic liver disease, complicated by portal hypertension (PH), may alter the extra-hepatic hemodynamic condition and spleen stiffness (SS). We aimed to evaluate the diagnostic accuracy of MRI-based elastographic methods (MRE) for detecting PH.
Seven studies were included with reference to SS with regard to the prediction of PH patients. Major outcomes considered for data extraction were diagnostic parameters for MRI for concluding mild PH, clinically significant PH and severe PH. PubMed, Scopus, Google Scholar, Cochrane and Science Direct databases were used to extract the published literature through to May, 2021Using the Rayyan Zotero and R softwares.
Out of 587 studies extracted, 7 were selected based on inclusion and exclusion criteria. A QUADAS-2 assessment showed that all studies were clear in terms of patient selection and reference standard. A funnel plot showed that all the selected studies were outliers, indicating a low level of accuracy for the studies included. Subgroup analysis, with reference to SS as a predictor of PH, revealed raw mean difference (RMD) of 7.78% (95% CI 5.23-10.34, <0.01). The corresponding RMD observed for <60 years and >60 yr were 34.26% (95% CI 9.33- 59.20, I=100%, τ=646.7688, =0), and 46.92% (95% CI 20-59.33, I=97%, τ=1003.023, =0) respectively. The specificity and sensitivity noted for MRI in determining SS were 0.721 and 0.747, respectively with an area-under the curve of 0.788. The estimated random effect models for specificity and sensitivity were 0.938 and 0.842, respectively.
The real-time MRE has acceptable specificity and sensitivity for diagnosing SS.
慢性肝病合并门静脉高压（PH）可能会改变肝外血流动力学状况和脾脏硬度（SS）。我们旨在评估基于磁共振弹性成像（MRE）的方法检测PH的诊断准确性。
纳入七项关于SS预测PH患者的研究。数据提取时考虑的主要结果是用于判定轻度PH、临床显著性PH和重度PH的MRI诊断参数。使用Rayyan Zotero和R软件，通过PubMed、Scopus、谷歌学术、Cochrane和科学Direct数据库提取截至2021年5月发表的文献。
在提取的587项研究中，根据纳入和排除标准选择了7项。QUADAS - 2评估显示，所有研究在患者选择和参考标准方面均清晰明确。漏斗图显示，所有选定研究均为离群值，表明纳入研究的准确性较低。以SS作为PH预测指标的亚组分析显示，原始平均差异（RMD）为7.78%（95%CI 5.23 - 10.34，<0.01）。在<60岁和>60岁人群中观察到的相应RMD分别为34.26%（95%CI 9.33 - 59.20，I = 100%，τ = 646.7688， = 0）和46.92%（95%CI 20 - 59.33，I = 97%，τ = 1003.023， = 0）。MRI测定SS的特异性和敏感性分别为0.721和0.747，曲线下面积为0.788。特异性和敏感性的估计随机效应模型分别为0.938和0.842。
实时MRE在诊断SS方面具有可接受的特异性和敏感性。
