增强CT对诊断肾脏占位性病变价值的Meta分析
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摘要
目的系统评价关于增强CT对诊断肾脏占位性病变的临床价值。方法计算机系统检索PubM ed、Cochrane Library、Embase、中国知网、维普数据库和中国生物医学文献数据库中关于增强CT诊断肾脏占位性病变的相关中英文文献,发表时间在2008年1月～2018年4月。应用Metadisc 1.4及Stata 15.1软件对纳入文献的研究数据进行统计学分析,并利用准确性研究(QUADAS)量表对纳入的文献进行质量评价。结果最终共纳入符合标准文献17篇,共包含1099个肾脏占位性病灶。各研究组间异质性明显,故采用随机效应模型。汇总增强CT诊断肾脏占位性病变的合并敏感度(SEN)、合并特异度(SPE)、诊断比数比(DOR)阳性似然化(+LR)、阴性似然比(-LR)、SROC曲线下面积(AUC)和Q指数分别为0.85(95%CI:0.82～0.87)、0.68(95%CI:0.62～0.74)、11.30(95%CI:6.53～19.55)、2.34 (95%CI:1.84～2.97)、0.24 (95%CI:0.17～0.32)、0.8489、0.7801。结论增强CT对于肾脏占位性病变良恶性诊断具有较好的临床价值。
Objective To systematically review the c Iinical value of contrast-enhanced CT(CECT) in diagnosis of renal space-occupying lesions. Methods Literatures concerning contrast-edhanced CT diagnosis of renal space-occupying lesions published from January 2008 to April 2018 were electronically searched in the databases including PubM ed,Cochrane Library, Embase, CNKI, VIP and CBM. Statistical analysis were performed via Metadisc 1.4 and Stata 15.1 software, and QUADAS scale was used to evaluate the quality of the enrolled literatures. Results Totally 17 literatures that met the standards were inrolled inc Iuding 1099 renal space-occupying lesions cases in total. The heterogeneity of the study group was obvious, so the random effect model was adopted. The combined sensitivity(SEN), combined specificity(SPE), diagnostic ratio(DOR), positive likelihood ratio(+LR), negative likelihood ratio(-LR), area under SROC curve(AUC) and Q index of the renal space-occupying lesions diagnosed by CECT were 0.85(95%CI: 0.82-0.87), 0.68(95%CI: 0.62-0.74), 11.30(95%CI: 6.53-19.55), 2.34(95%CI:1.84-2.97), 0.24(95%CI:0.17-0.32), 0.8489, 0.7801.Conciusion CECT is effective in the diagnosis of benign and malignant renal space-occupying lesions.
Objective To systematically review the c Iinical value of contrast-enhanced CT(CECT) in diagnosis of renal space-occupying lesions. Methods Literatures concerning contrast-edhanced CT diagnosis of renal space-occupying lesions published from January 2008 to April 2018 were electronically searched in the databases including PubM ed,Cochrane Library, Embase, CNKI, VIP and CBM. Statistical analysis were performed via Metadisc 1.4 and Stata 15.1 software, and QUADAS scale was used to evaluate the quality of the enrolled literatures. Results Totally 17 literatures that met the standards were inrolled inc Iuding 1099 renal space-occupying lesions cases in total. The heterogeneity of the study group was obvious, so the random effect model was adopted. The combined sensitivity(SEN), combined specificity(SPE), diagnostic ratio(DOR), positive likelihood ratio(+LR), negative likelihood ratio(-LR), area under SROC curve(AUC) and Q index of the renal space-occupying lesions diagnosed by CECT were 0.85(95%CI: 0.82-0.87), 0.68(95%CI: 0.62-0.74), 11.30(95%CI: 6.53-19.55), 2.34(95%CI:1.84-2.97), 0.24(95%CI:0.17-0.32), 0.8489, 0.7801.Conciusion CECT is effective in the diagnosis of benign and malignant renal space-occupying lesions.
引文
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[19]袁新春,王宇,周爱云,等.对比超声造影与CT诊断肾细胞癌[J].中国医学影像技术,2011,27(12):2502-2505.
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[21]李萍,李凤华,方华,等.超声造影和增强CT在肾实质良恶性病灶诊断中的应用比较[J].中国医学影像技术,2009,25(5):844-847.
[22]李维国,朱轶勇,阮渊,等.超声造影在小肾癌诊断中的价值探讨[J].临床泌尿外科杂志,2009,24(1):32-34.
[23]刘进,杨嗣星,陈文卫,等.超声造影在临床诊断小肾癌中的价值[J].临床泌尿外科杂志,2008,23(7):499-501.
[24]Atri M,Tabatabaeifar L,Jang HJ,et al.Accuracy of Contrast-enhanced US for Differentiating Benign from Malignant Solid Small Renal Masses[J].Radiology,2015,276(3):900-908.
[25]Thorelius L.Contrast-enhanced ultrasound for extrahepatic lesions:preliminary experience[J].Eur J Radiol,2004,51(6):31-38.
[26]CIevert DA,Minaifar N,Weckbach S,et al.Multislice computed tomography versus contrast-enhanced ultrasound in evaluation of complex cystic renal masses using the Bosniak CIassification system[J].CIin Hemorheol Microcirc,2008,39(1/4):171-178.
[27]Quaia E,Siracusano S,Bertolotto M,et al.Characterization of renal tumours with pulse inversion harmonic imaging by intermittent high mechanical index technique:initial results[J].Eur Radiol,2003,13(6):1402-1412.
[2]Hatcher PA,Anderson EE,Paulson DF,et al.Surgical management and prognosis of renal cell carcinoma invading the vena cava[J].J Urol,1991,145(1):23-24.
[3]Levine E,Lee KR,Weigel J.Preoperative determination of abdominal extent of renal cell carcinoma by computed tomography[J].Radiology,1979,132(2):395-398.
[4]邓亿明.CT诊断104例肾脏肿瘤的临床价值[J].中外医疗,2011,30(36):179.
[5]Ignee A,Straub B,Brix D,et al.The value of contrast enhanced ultrasound(CEUS)in the characterisation of patients with renal masses[J].CIin Hemorheol Microcirc,2010,46(4):275-290.
[6]Whiting P,Rutjes AW,Reitsma JB,et al.The development of QUADAS:a tool for the quality assessment of studies of diagnostic-mositic accuracy included in systematic reviews[J].BMC Med Res Methodol,2003,3(3):25.
[7]Wei SP,Xu CL,Zhang Q,et al.Contrast-enhanced ultrasound for differentiating benign from malignant solid small renal masses:comparison with contrast-enhanced CT[J].Abdom Radiol,2017,42(5):2135-2145.
[8]刘阳,范小明,叶瑞忠,等.超声造影与多层螺旋CT增强扫描在肾肿瘤诊断中的对照研究简[J].中国临床保健杂志,2016,19(3):270-272.
[9]闫行健.超声造影对小肾癌的诊断价值[D].长春:吉林大学,2016.
[10]李灿.肾脏占位病变超声造影与增强CT的对比研究[D].衡阳:南华大学,2015.
[11]赵建华,阿力木·吐拉洪,王晨宇,等.超声造影与增强CT在诊断小于3 cm肾肿瘤中的对比研究[J].国际泌尿系统杂志,2014,34(6):852-856.
[12]韩文英.超声造影与增强CT在肾肿瘤鉴别诊断中的对比研究[D].长春:吉林大学,2014.
[13]王艳,王辉,查小霞,等.超声造影与增强CT鉴别诊断肾实质性恶性肿瘤的临床价值比较[J].现代生物医学进展,2013,13(24):4667-4670.
[14]张建新.肾癌超声造影和增强CT扫描检查的一致性及特点对比[J].中国医药指南,2013,11(30):431-432.
[15]许进,姚欣.超声造影与增强CT在鉴别诊断肾实质性肿瘤中的对比研究[J].中国医药导报,2012,9(33):96-97.
[16]雷丽,傅宁华,杨斌,等.对比分析超声造影及增强CT诊断小肾癌[J].中国医学影像技术,2012,28(4):760-764.
[17]李春香,姚欣,李秀英,等.超声造影对≤4 cm肾脏良恶性病变的诊断价值[J].中国肿瘤临床,2011,38(9):520-523.
[18]陈松华,杨斌,卢光明.超声造影与增强CT对肾癌的诊断分析[J].医学影像学杂志,2011,21(9):1382-1385.
[19]袁新春,王宇,周爱云,等.对比超声造影与CT诊断肾细胞癌[J].中国医学影像技术,2011,27(12):2502-2505.
[20]宋庆飞.超声造影与增强螺旋CT在肾肿瘤诊断中的对照研究[D].太原:山西医科大学,2010.
[21]李萍,李凤华,方华,等.超声造影和增强CT在肾实质良恶性病灶诊断中的应用比较[J].中国医学影像技术,2009,25(5):844-847.
[22]李维国,朱轶勇,阮渊,等.超声造影在小肾癌诊断中的价值探讨[J].临床泌尿外科杂志,2009,24(1):32-34.
[23]刘进,杨嗣星,陈文卫,等.超声造影在临床诊断小肾癌中的价值[J].临床泌尿外科杂志,2008,23(7):499-501.
[24]Atri M,Tabatabaeifar L,Jang HJ,et al.Accuracy of Contrast-enhanced US for Differentiating Benign from Malignant Solid Small Renal Masses[J].Radiology,2015,276(3):900-908.
[25]Thorelius L.Contrast-enhanced ultrasound for extrahepatic lesions:preliminary experience[J].Eur J Radiol,2004,51(6):31-38.
[26]CIevert DA,Minaifar N,Weckbach S,et al.Multislice computed tomography versus contrast-enhanced ultrasound in evaluation of complex cystic renal masses using the Bosniak CIassification system[J].CIin Hemorheol Microcirc,2008,39(1/4):171-178.
[27]Quaia E,Siracusano S,Bertolotto M,et al.Characterization of renal tumours with pulse inversion harmonic imaging by intermittent high mechanical index technique:initial results[J].Eur Radiol,2003,13(6):1402-1412.