螺旋CT不同动态增强扫描方式对小肝癌诊断价值的比较

Comparison of helical CT scanning with different dynamic enhancements in diagnosis of small hepatic carcinoma

目的:通过Meta分析来比较两种螺旋CT动态增 强扫描方式(动脉晚期A2+门脉期P+延迟期D,动脉早期 A1+动脉晚期A2+门脉期P)对小肝癌的诊断价值,并对其 临床价值作出评估.方法:检索Cochrane图书馆,Pubmed,Ov id,Embase数据库(1990/2004)和中国期刊网(1994/2004)的 英文和中文文献,按照循证医学诊断试验的评价标准筛选有 关动态增强螺旋CT诊断小肝癌的中英文文献.采用权重灵敏 度,权重特异度,权重lnDOR及SROC曲线下面积评价两种三 期动态增强扫描方式对小肝癌的诊断价值.结果:共有11篇 英文文献满足标准纳入研究,6篇为A2+P+D动态扫描方 式,5篇为A1+A2+P动态扫描方式.二者的权重灵敏度分别 为84%,88%,权重特异度分别为94%,85%,权重lnDOR分 别为4.50,3.91.汇总受试者工作特征曲线(SROC)下面积分 别为89.12%,90.28%,组间比较P>0.05.

AIM: To compare the performance of two dynamic enhancements for helical CT scanning in the diagnosis of small hepatic carcinoma by Meta analysis (the late arterial phase A2+portal venous phase P+delayed phase D,the early arterial phase A1+late arterial phase A2+portal venous phase P) and to assess their clinical value.METHODS: Pubmed,Ovid,Embase databases (1990/2004) and CNKI database (1994/2004) were searched for the related articles in English and Chinese respectively.By the assessment standard of Evidence-based Medicine,English and Chinese literature on the dynamic enhancement for helical CT scanning was screened.Pooled weighted sensitivity,pooled weighted specificity,pooled weighted lnDOR and the area under SROC were used to assess the performance of two types of three-phased dynamic enhanced scanning of helical CT in the diagnosis of small hepatic carcinoma.RESULTS: Altogether 11 articles in English that met the standard were included,6 of which used A2+P+D dynamic scanning and 5 of which used A1+A2+ P dynamic scanning.The pooled weighted sensitivity of the two types was 84% and 88% respectively,the pooled weighted specificity of them was 94% and 85% respectively and the pooled weighted lnDOR was 4.50 and 3.91 respectively.The area under SROC curve was 89.12% and 90.28% respectively (P>0.05).CONCLUSION: Considering the overall sensitivity and specificity, the two types of helical CT dynamic enhancements both have high accuracy in the diagnosis of small hepatic carcinoma,but the approach of A1+A2+P was higher in its sensitivity and A2+P+D was higher in the specificity.The latter has a higher clinical value for its easy operation and relatively low requirement of equipment.