64排螺旋CT冠状动脉成像评价冠状动脉狭窄准确性的Meta分析
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摘要
目的对以侵入性冠状动脉造影(ICA)为金标准,研究64排螺旋CT冠状动脉成像(64-row CCTA)诊断冠状动脉狭窄的文献进行Meta分析,评价64-row CCTA对冠状动脉狭窄的临床诊断价值。方法检索Cochrane图书馆、OVID循证医学数据库、Pub Med、中国期刊网中的中、英文文献。按照Cochrane协作网推荐的诊断试验纳入标准筛选文献,提取纳入研究的特征信息。数据分析采用Rev Man 5.3统计软件,检验异质性,并根据异质性结果选择相应的效应模型。对所有研究进行加权定量合并,计算汇总敏感性(Se)、汇总特异性(Sp)及95%可信区间(CI)。绘制汇总受试者工作特征曲线(SROC),计算曲线下面积。结果共纳入69篇文献,均存在异质性,按照随机效应模型,汇总Se=0.92,95%CI=(0.91,0.92);汇总Sp=0.95,95%CI=(0.95,0.96);SROC曲线下面积为98.60%。结论 64-row CCTA诊断冠状动脉狭窄具有较高的Se和Sp,是一种高效、无创的检查方法。
Objective To assess the overall value of 64-row coronary computed tomography angiography(64-row CCTA) in diagnosis of coronary artery stenosis with invasive coronary angiography(ICA) as the gold standard. Methods A search in Cochrane Library, OVID, Pub Med and CNKI was performed to identify relevant English and Chinese language articles. Criteria for inclusion were established based on validity criteria for diagnostic research published by the Cochrane Methods Group on Screening and Diagnostic Tests.Subsequently, the characteristics of the included articles were appraised and extracted. Statistical analysis was performed employing Rev Man 5.3, Meta-Disc 1.4. Heterogeneity of the included articles was tested, which was used to select proper effect model. Pooled weighted sensitivity and specificity were calculated. Summary Receiver Operating Characteristic(SROC) curve was drawn and the area under the curve(AUC) was calculated. Results Of the 479 retrieved articles, 69 were included. The pooled weighted sensitivity and specificity with 95% confidence interval(95% CI) were 0.92(0.91-0.92) and 0.95(0.95-0.96), respectively.The area under the SROC curve was 98.60%. Conclusions 64-row CCTA has a highly accurate sensitivity and specificity with a strong ROC curve making it an alternative non-invasive method in the diagnosis of coronary artery stenosis.
Objective To assess the overall value of 64-row coronary computed tomography angiography(64-row CCTA) in diagnosis of coronary artery stenosis with invasive coronary angiography(ICA) as the gold standard. Methods A search in Cochrane Library, OVID, Pub Med and CNKI was performed to identify relevant English and Chinese language articles. Criteria for inclusion were established based on validity criteria for diagnostic research published by the Cochrane Methods Group on Screening and Diagnostic Tests.Subsequently, the characteristics of the included articles were appraised and extracted. Statistical analysis was performed employing Rev Man 5.3, Meta-Disc 1.4. Heterogeneity of the included articles was tested, which was used to select proper effect model. Pooled weighted sensitivity and specificity were calculated. Summary Receiver Operating Characteristic(SROC) curve was drawn and the area under the curve(AUC) was calculated. Results Of the 479 retrieved articles, 69 were included. The pooled weighted sensitivity and specificity with 95% confidence interval(95% CI) were 0.92(0.91-0.92) and 0.95(0.95-0.96), respectively.The area under the SROC curve was 98.60%. Conclusions 64-row CCTA has a highly accurate sensitivity and specificity with a strong ROC curve making it an alternative non-invasive method in the diagnosis of coronary artery stenosis.
引文
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[3]Sajjadieh A,Hekmatnia A,Keivani M,et al.Diagnostic performance of 64-row coronary CT angiography in detecting significant stenosis as compared with conventional invasive coronary angiography[J].ARYA Atheroscler,2013,9(2):157-163.
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[5]Maffei E,Seitun S,Nieman K,et al.Assessment of coronary artery disease and calcified coronary plaque burden by computed tomography in patients with and without diabetes mellitus[J].Eur Radiol,2011,21(5):944-953.
[6]Ziegler F,Leber AW,Becker A,et al.Detection of significant coronary artery stenosis with 64-slice computed tomography in heart transplant recipients:a comparative study with conventional coronary angiography[J].Int J Cardiovasc Imaging,2009,25(1):91-100.
[7]Boulmier D,Audinet C,Heautot JF,et al.Clinical contributions of 64-slice computed tomography in the evaluation of cardiomyopathy of unknown origin[J].Arch Cardiovasc Dis,2009,102(10):685-696.
[8]Meijboom WB,Meijs MFL,Schijf JD,et al.Diagnostic accuracy of 64-slice computed tomography coronary angiography:a prospective,multicenter,multivendor study[J].Journal of the American College of Cardiology,2008,52:2135-2144.
[9]Cademartiri F,Maffei E,Notarangelo F,et al.64-slice computed tomography coronary angiography:diagnostic accuracy in the real world[J].Radiol Med,2008,113(2):163-180.
[10]Cademartiri F,Maffei E,Palumbo A,et al.Diagnostic accuracy of 64-slice computed tomography coronary angiography in patients with low-to-intermediate risk[J].Radiol Med,2007,112(7):969-981.
[11]Shabestari AA,Abdi S,Akhlaghpoor S,et al.Diagnostic performance of 64-channel multislice computed tomography in assessment of significant coronary artery disease in symptomatic subjects[J].Am J Cardiol,2007,99(12):1656-1661.
[12]Pugliese F,Mollet NR,Runza G,et al.Diagnostic accuracy of non-invasive 64-slice CT coronary angiography in patients with stable angina pectoris[J].Eur Radiol,2006,16:575-582.
[13]Ropers D,Rixe J,Anders K,et al.Usefulness of multislice row spiral computed tomography with 64×0.6 mm collimation and330ms rotation for the noninvasive detection of significant coronary artery stenoses[J].Am J Cardiol,2006,97:343-348.
[14]Nikolaou K,Knez A,Rist C,et al.Accuracy of 64-MDCT in the diagnosis of ischemic heart disease[J].AJR Am J Roentgenol,2006,187:111-117.
[15]Ghostine S,Caussin C,Daoud B,et al.Non-invasive detection of coronary artery disease in patients with left bundle branch block using 64-slice computed tomography[J].J Am Coll Cardiol,2006,48(10):1929-1934.
[16]Meijboom WB,Mollet NR,Van Mieghem CAG,et al.Pre-operative computed tomography coronary angiography to detect significant coronary artery disease in patients referred for cardiac valve surgery[J].J Am Coll Cardiol,2006,48(8):1658-1665.
[17]Schuijf JD,Pundziute G,Jukema JW,et al.Diagnostic accuracy of 64-slice multislice computed tomography in the non-invasive evaluation of significant coronary artery disease[J].Am J Cardiol,2006,98:145-148.
[18]Plass A,Grünenfelder J,Leschka S,et al.Coronary artery imaging with 64-slice computed tomography from cardiac surgical perspective[J].Eur J Cardiothorac Surg,2006,30(1):109-116.
[19]Ehara M,Surmely JF,Kawai M,et al.Diagnostic accuracy of64-slice computed tomography for detecting angiographically significant coronary artery stenosis in an unselected consecutive patient population-comparison with conventional invasive angiography[J].Circ J,2006,70:564-571.
[20]Mollet NR,Cademartiri F,van Mieghem CA,et al.High-resolution spiral computed tomography coronary angiography in patients referred for diagnostic conventional coronary angiography[J].Circulation,2005,112(15):2318-2323.
[21]Raff GL,Michael J.Diagnostic accuracy of noninvasive coronary angiography using 64-slice spiral computed tomography[J].J Am Coll Cardiol,2005,46:552-557.
[22]Leschka S,Alkadhi H,Plass A,et al.Accuracy of MSCT coronary angiography with 64-slice technology:first experience[J].Eur Heart J,2005,26(15):1482-1487.
[23]Leber AW,Knez A,Von Ziegler F,et al.Quantification of obstuctive and nonobstructive coronary lesions by 64-slice computed tomography[J].J Am Coll Cardiol,2005,46:147-154.
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