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目的: 通过meta、ROC 分析以及按病变部位、性质进行的亚组分析分析对目前诊断梗阻性黄疸的非侵入性影像诊断方法(US, CT 和MRCP) 进行对比研究。方法: 1. 采用medline 检索。纳入标准为: ( a) US、CT 和MRCP 诊断梗阻性黄疸性疾病的文献 ( b) 病理检查、术中所见或临床、实验室检查结果作为诊断金标准。( c) 能够直接或间接获得每个影像方法的真、假阳性数, 真、假阴性数。提取数据、文献质量评估通过kappa 分析进行一致性检验。统计分析采用漏斗图、SROC 分析方法以及协变量分析。 2. 疑胆胰系疾患接受MRCP 检查患者105 例, 其中同时做US 检查者65 例。另有同期CT 资料59 例, 其中同时做US 检查者31 例。盲法与金标准对比, 计算出各诊断方法的真阳性率和假阳性率, ROC 分析其诊断效能。同时按病变部位、性质分别计算MRCP 、US 及CT 的敏感度、特异度和似然比等指标进行比较分析。结果: 1. 漏斗图US 相关文献分布形状略不规则, CT、MRCP 相关文献分布形状类似漏斗形。SROC 曲线图MRCP 线最靠近左上角, 诊断效能高于US 和CT. MRCP 的Q* 值( 0. 9256) 高于US( 0. 8765) 和CT( 0. 8606) 。三者间经检验无显著性差别, MRCP 和CT 间检验Z= 0. 33, 双侧P> 0. 25。协变量分析未见对诊断效能有显著性影响因素。2. ROC 分析显示,MRCP 的曲线最靠近左上角, US 次之, CT 在最下面, 三者的曲线下面积( AZ) 分别为0. 985, 0. 981, 0. 901, 均大于0. 9, MRCP 与CT 间离均差( Z) 为0. 75, 双侧P> 0. 25。MRCP、US 和CT 诊断胆胰系恶性占位、结石的敏感度分别为 100%、83%、82%; 92%、71%、76%。经检验, MRCP 与US 和CT 间有显著性差异, p< 0. 05。结论: 经meta、ROC 分析, 认为MRCP 在诊断梗阻性黄疸疾病中具有优势, 诊断效能高于US 和CT。

英文摘要:

Objective: To perform a meta- analysis and Receiver Operating Characteristic curves( ROC) to compare current noninvasive imaging methods, such as ultrasonography ( US) , computed tomography ( CT) , magnetic resonance cholangiopancreatography (MRCP) in the detection of obstructive jaundice disease. Mathods: 1. A MEDLINE literature search was performed. Articles were included if ( a) US, CT and/ or MRCP were performed for evaluation of Obstructive jaundice disease ( b) Pathological results, operating findings or clinical and laboratorial exam-i nation results were the reference standards and ( c) absolute numbers of true- positive, false- negative, true- negative and false- positive results were available or derivable. The k value was calculated as a measure of agreement between extracted variables and quality score. Funnel plot and Summary receiver operating characteristic ( SROC) were obtained and a covariate analysis was used to evaluate the influence of patient or study- related factors on sensitivity. 2. We collected 105 patients suspected with cholangiopancreatic disease. All patients were detected with MR. Of them, 65 patients underwent US examination. Additional computed tomography for 59 patients, of them, Ultrasound was performed in 31 patients. True positive rate and false positive ratewere calculated, respectively. We analysed the data with ROC. According to location and cause of the obstruction, sensitivity, specificity and likelihood ratio were calculated, respectively. Results: 1. The funnel plot demonstrated a symmetric funnel- shaped distribution for the CT andMRCP studies. SROC analysis demonstrated better discriminatory power for MRCP than for US and CT. The value of Q* for MRCP( 0. 9256) was higher than that for US( 0. 8765) and CT( 0. 8606) , but there was no significant difference between MRCP and CT ( Z= 0. 33, P> 0. 05) . Covariate factors had no influence on sensitivity by covariate analysis. 2. ROC curve showedMRCP curve lied in top left corner and demonstrated better discriminatory power for MRCP than for US and CT. Areas under the ROC curve ( AZ) of Ultrasound, CT and MRCP were 0. 981, 0. 901and 0. 985, all AZ values of them, higher than 0. 9. But there was no significant difference between MRCP and CT ( Z= 0. 75, P> 0. 05) . The sensitivity ofMRCP in distinguishing the various pancreato- biliary tumors and stones was significantly higher than that of US and CT ( p< 0. 05) . Conclusion: MRCP is considered to be superior to US and CT for the diagnosis of obstructive jaundice disease.

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