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目的采用Meta分析法比较CT血管成像(computer tomography angiography,CTA)和MR血管成像(magnetic resonance angiography,MRA)对颅内动脉瘤的诊断价值。方法检索Cochrane图书馆、Medline、Ovid数据库和中国期刊网中有关的中英文文献,按照Cochran协作网推荐的诊断试验纳入标准选取A级文献,并提取纳入研究的诊断信息。统计分析采用Meta-Test version0.9软件,检验异质性,再根据异质性结果选择相应的效应模型。对所纳入的研究予以加权定量合并,计算汇总敏感度和特异度及其95%可信区间,绘制汇总受试者工作特征曲线(SROC)。结果按照纳入标准共获取文献11篇,其中有关CTA诊断颅内动脉瘤4篇(单层螺旋CT),MRA为5篇[三维时间飞跃法(3D TOF)],二者共同研究者2篇;前瞻性研究7篇,回顾性4篇;各组研究均存在异质性,按照随机效应模型对纳入文献行汇总分析。结果显示,对于每个颅内动脉瘤CTA诊断的敏感度、特异度及95%可信区间分别为0.84(0.78～0.88)和0.77(0.68～0.84),MRA分别为0.68(0.63～0.72)和0.76(0.70～0.82);SROC曲线下面积分别为95.40%和79.71%。结论对于每个颅内动脉瘤,CTA诊断的准确性明显高于3D TOF法MRA。
Objective To compare the diagnostic value of computed tomography angiography (CTA) and magnetic resonance angiography (MRA) for intracranial aneurysms by Meta-analysis. Methods The Cochrane Library, Medline, Ovid database and Chinese Journal of Chinese and English literature were retrieved. The A - files were selected according to the diagnostic tests recommended by the Cochrane Collaboration, and the diagnostic information included in the study was extracted. Statistical analysis using Meta-Test version0.9 software, test heterogeneity, and then select the appropriate effect model based on heterogeneity results. The included studies were weighted quantitatively and the summary sensitivity and specificity and their 95% confidence intervals were calculated and the summary receiver operating characteristic (SROC) plotted. Results A total of 11 literatures were obtained according to the inclusion criteria. Among them, 4 were CTA for diagnosis of intracranial aneurysms and 5 were for MRA [3D TOF]. There were 2 co-investigators in both groups. 7 cases were prospectively studied and 4 were retrospectively reviewed. The heterogeneity of all the studies in each group was summarized according to the random effects model. The results showed that the sensitivity, specificity, and 95% confidence intervals of CTA for each intracranial aneurysm were 0.84 (0.78-0.88) and 0.77 (0.68-0.84), respectively. The MRA was 0.68 (0.63-0.72) and 0.76 (0.70-0.82). The area under the curve of SROC was 95.40% and 79.71% respectively. Conclusions For each intracranial aneurysm, the diagnostic accuracy of CTA is significantly higher than that of 3D TOF MRA.