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目的系统评价3D-TOF-MRA诊断颅内动脉瘤(IAN)的临床价值。方法计算机检索CNKI、EBM、VIP、Wanfang data中文数据库以及Cochrane Library、Pub Med、Embase、Web of Science外文数据库中3D-TOF-MRA诊断IAN的文献,检索时间截止至2016年9月。由两位评价员按照预先设定的纳入与排除标准独立筛选文献、提取资料,利用QUADAS-2工具评价纳入研究的偏倚风险后,采用Stata 12.0软件进行Meta分析,计算合并敏感性(Sen)、特异性(Spe)、阳性似然比(+LR)、阴性似然比(-LR)、诊断比值比(DOR),绘制受试者工作特征(SROC)曲线并计算曲线下面积(AUC)。结果最终纳入27篇文献的34个研究,共计4886例患者和2003枚可疑IAN。Meta分析结果显示,3D-TOF-MRA诊断颅内动脉瘤的Sen_(合并)=0.95[95%CI(0.93,0.97)]、Spe_(合并)=0.95[95%CI(0.92,0.97)]、+LR_(合并)=19.39[95%CI(11.51,32.67)]、-LR_(合并)=0.05[95%CI(0.03,0.08)]、DOR_(合并)=375.85[95%CI(174.87,807.83)]、AUC=0.99[95%CI(0.97,0.99)]。亚组分析结果:3D-TOF-MRA在3.0T高场强诊断IAN的敏感性高于1.5 T低场强(P<0.05),研究标准和有无蛛网膜下腔出血对3D-TOF-MRA诊断IAN影响不显著(P>0.05)。结论 3D-TOF-MRA对诊断颅内动脉瘤具有明确的诊断价值,高场强能提高3D-TOF-MRA诊断IAN的价值。
Objective To evaluate the clinical value of 3D-TOF-MRA in the diagnosis of intracranial aneurysms (IAN). Methods The databases of CNKI, EBM, VIP and Wanfang data Chinese databases and 3D-TOF-MRA diagnosis of IAN in the Cochrane Library, Pub Med, Embase and Web of Science databases were retrieved by computer. The search time was up to September 2016. Two reviewers independently screened and extracted data according to pre-established inclusion and exclusion criteria. The risk of bias in the study was assessed using the QUADAS-2 tool. Meta-analysis was performed using Stata 12.0 software to calculate the combined sensitivity (Sen) Specificity (Spe), Positive Likelihood Ratio (LR), Negative Likelihood Ratio (LR), diagnostic odds ratio (DOR) were calculated. The receiver operating characteristic (SROC) curve was plotted and the area under the curve (AUC) was calculated. Results Finally, 34 studies were included in 27 articles, for a total of 4886 patients and 2003 suspect IAN. Meta-analysis showed that Sen_ (pooled) of 3D-TOF-MRA for intracranial aneurysm was 0.95 [95% CI (0.93,0.97)] and Spe_ (pooled) was 0.95 [95% CI (0.92,0.97) + LR_ (pooled) = 19.39 [95% CI (11.51,32.67)], - LR_ (pooled) = 0.05 [95% CI (0.03,0.08)], DOR_ (pooled) = 375.85 [95% CI (174.87,807.83 )], AUC = 0.99 [95% CI (0.97, 0.99)]. Results of subgroup analysis: The sensitivity of 3D-TOF-MRA in diagnosis of IAN at 3.0T was higher than that of 1.5T at low field strength (P <0.05), and the research criteria and the presence or absence of subarachnoid hemorrhage had no significant effect on 3D-TOF-MRA Diagnostic IAN had no significant effect (P> 0.05). Conclusion 3D-TOF-MRA has a clear diagnostic value for the diagnosis of intracranial aneurysms. High field intensity can improve the value of 3D-TOF-MRA in diagnosis of IAN.