螺旋CT小肠成像检测小肠肿瘤的meta分析

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目的通过meta分析来确定螺旋CT小肠成像检测小肠肿瘤的敏感度及特异度的估计值。方法收集1992年1月—2010年11月发表的相关文章。记录研究设计、病人特点及2×2列联表作为有效研究。采用I2统计进行异质性检验。采用一个二元广义线性随机效应模型总结以每例病人为基础的小肠肿瘤检测的敏感度及特异度估计值。比较不同亚组的敏感度及特异度估计值。结果 12项研究(696例病人)符合本研究要求。小肠肿瘤平均发病率为22.6%(范围7.7%~45.8%)。各研究间敏感度异质性较大(I2=66.9%;95%CI:28.7%~88.5%),特异度异质性较小(I2=10.6%;95%CI:0~55.0%)。以每病人为基础时,小肠肿瘤诊断的汇总敏感度为92.8%(95%CI:71.3%~98.5%),汇总特异度为99.2%(95%CI:94.2%~99.9%)。对小肠准备的亚组分析显示,一次以上的期相成像过程及大容量(≥2L)肠内对比剂不能提高肿瘤检测。结论 meta分析证实螺旋CT小肠成像在小肠肿瘤检测中具有较高的敏感度和特异度。然而,本研究结果强调需要更多标准化个体性研究。要点①螺旋CT小肠成像在小肠肿瘤诊断中具有较高敏感性。②螺旋CT小肠成像在小肠肿瘤诊断中具有较高特异性。③螺旋CT小肠成像可作为一线研究方法。④一次肠道期相检查可达到最佳的肿瘤检测。 Objective To determine the sensitivity and specificity of spiral CT in the detection of intestinal tumors by meta-analysis. Methods The related articles published from January 1992 to November 2010 were collected. Record study design, patient characteristics, and 2 × 2 contingency tables as validated studies. Using I2 statistics to test heterogeneity. A binary generalized linear stochastic effect model was used to summarize the sensitivity and specificity estimates for each patient-based small intestinal tumor assay. Sensitivity and specificity estimates from different subgroups were compared. Results 12 studies (696 patients) met the requirements of this study. The average incidence of intestinal tumors was 22.6% (range 7.7% ~ 45.8%). Heterozygosities were more heterogeneous (I2 = 66.9%; 95% CI: 28.7% to 88.5%) and less heterogeneous (I2 = 10.6%; 95% CI: 0-55.0%) among studies. On a patient-by-patient basis, the aggregate sensitivity for small bowel tumors was 92.8% (95% CI: 71.3% -98.5%) and 99.2% (95% CI: 94.2% -99.9%). Subgroup analyzes of the small intestine showed that more than one phase imaging and large volume (> 2 L) of intestinal contrast agent did not improve tumor detection. Conclusions Meta-analysis confirmed that spiral CT small bowel imaging has high sensitivity and specificity in the detection of small bowel tumors. However, the results of this study emphasize the need for more standardized individual studies. Points ① spiral CT small bowel imaging in the diagnosis of small bowel cancer has a higher sensitivity. ② spiral CT small bowel imaging in the diagnosis of small bowel tumor has a high specificity. ③ spiral CT small bowel imaging can be used as first-line research methods. ④ an intestinal phase examination can achieve the best tumor detection.
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