Qin Yong, Tian Lu, Chen Xia, Li Qiu
Department of Radiology, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China.
Department of Outpatient Surgery, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China.
Abdom Radiol (NY). 2025 Feb;50(2):851-859. doi: 10.1007/s00261-024-04473-8. Epub 2024 Aug 23.
Nutcracker syndrome (NCS) can be caused by narrowness of the superior mesenteric artery (SMA) angle. Nevertheless, the cut-off value of the SMA angle is controversial and variable. Therefore, the present study evaluated the optimal SMA angle to maximize diagnostic performance for NCS diagnosis by conducting a meta-analysis.
We comprehensively searched the English literature related to the diagnosis of NCS from the perspective of SMA (from the date of database inception to June 2022). The accuracy of an SMA angle less than 41° in the diagnosis of NCS was evaluated by calculating the pooled sensitivity (SEN), pooled specificity (SPE), positive likelihood ratio (LR+), negative likelihood ratio (LR-), summary receiver operating characteristic (SROC) curve and area under the curve (AUC) value. The I test and meta-regression analysis were used to assess heterogeneity and sources of heterogeneity, respectively. Publication bias was assessed using Deeks' funnel plot asymmetry test.
Six studies (526 patients) met the inclusion criteria. SEN and SPE were 0.94 (95% confidence interval (CI) 0.80-0.99) and 0.85 (95% CI 0.65-0.94), respectively. The LR + value was 6.0, and the LR- value was 0.07, revealing that SMA angles less than 41° exhibited an excellent ability to help confirm or exclude NCS. Additionally, SROC curves showed that the AUC of SMA angles less than 41° for the diagnosis of NCS was 0.96, indicating that SMA angles less than 41° have good efficacy for helping to diagnose NCS.
This study explored the diagnostic efficacy of the cut-off value of the SMA angle by meta-analysis. According to the high SPE and SEN results, SMA angles less than 41° have good efficacy in facilitating NCS diagnosis.
胡桃夹综合征（NCS）可由肠系膜上动脉（SMA）夹角变窄引起。然而，SMA夹角的截断值存在争议且各不相同。因此，本研究通过进行荟萃分析评估了用于NCS诊断的最佳SMA夹角，以最大限度地提高诊断性能。
我们从SMA角度全面检索了与NCS诊断相关的英文文献（从数据库建立之日至2022年6月）。通过计算合并敏感度（SEN）、合并特异度（SPE）、阳性似然比（LR+）、阴性似然比（LR-）、汇总接受者操作特征（SROC）曲线和曲线下面积（AUC）值，评估SMA夹角小于41°在NCS诊断中的准确性。分别使用I检验和荟萃回归分析评估异质性及异质性来源。采用Deeks漏斗图不对称性检验评估发表偏倚。
六项研究（526例患者）符合纳入标准。SEN和SPE分别为0.94（95%置信区间（CI）0.80 - 0.99）和0.85（95%CI 0.65 - 0.94）。LR +值为6.0，LR -值为0.07，表明SMA夹角小于41°在帮助确认或排除NCS方面具有出色能力。此外，SROC曲线显示SMA夹角小于41°用于NCS诊断的AUC为0.96，表明SMA夹角小于41°在帮助诊断NCS方面具有良好效果。
本研究通过荟萃分析探讨了SMA夹角截断值的诊断效力。根据高SPE和SEN结果，SMA夹角小于41°在促进NCS诊断方面具有良好效果。
