腰椎间盘突出症CT、MRI诊断的定量评价

Quantitative evaluation for diagnostic efficacy of computed tomography and magnetic resonance imaging in patients with lumbar disc herniation

目的 采用荟萃（Meta）分析法定量评价椎间盘突出症的CT和MRI诊断价值与效能.方法 检索PubMed数据库、Cochrane图书馆、OVID数据库以及中国期刊网1980至2010年公开发表的英文、中文文献,按照Cochrane协作网推荐的诊断试验纳入标准筛选文献,提取纳入研究各文献的诊断信息真阳性值、假阳性值、真阴性值、假阴性值.采用Meta-Disc version 1.4软件、SPSS 13.0软件、Comprehensive Meta-analysis version 2软件,对数据进行统计学处理,包括异质性检验,确定相应的效应模型予以加权定量合并;对纳入文献进行发表性偏倚分析;计算汇总灵敏性和汇总特异性及其95%可信区间;绘制汇总受试者工作特征曲线（SROC）并计算曲线下面积,对CT、MRI对腰椎间盘突出的诊断性能进行概括和评价,最后进行敏感性分析.结果 按照纳入标准共获取文献9篇,结果显示,CT诊断腰椎间盘突出症的汇总灵敏性和特异性及95%可信区间为0.73（0.68～0.77）和0.78（0.72～0.82）,MRI诊断腰椎间盘突出症的汇总灵敏性和特异性及95%可信区间为0.88（0.83～0.91）和0.79（0.71～0.87）,CT和MRI汇总灵敏性的差异有统计学意义（P＜0.05）,CT和MRI汇总特异性的差异无统计学意义（P＞0.05）;CT和MRI的SROC曲线下面积分别为83.5%和88.8%,两者差异有统计学意义（P＜0.05）.结论 经Meta分析和统计学检验,MRI诊断的准确性优于CT.

Objective To evaluate the diagnostic performances of CT and MRI in patients with lumbar intervertebral disc herniation through the Meta analytical method. Method The relevant English and Chinese articles published between 1980 and 2010 were searched in PubMed, Medline, Ovid database,Cochrane library and Chinese Periodical Web. According to the criteria for diagnostic researches published by Cochrane Method Group on Screening and Diagnostic Tests, each article was critically appraised and screened with regards to the absolute numbers of true-positive, false-negative, true-negative and falsepositive. Statistical analysis was performed by the Meta-Disc version 1.4, SPSS 13. 0 and Comprehensive Meta-analysis version Ⅱ. Heterogeneity was tested and publication bias analyzed. And the pooled weighted sensitivity and specificity and the corresponding 95% CI were calculated. The summary receiver operating characteristic （SROC） curve was performed and the area under the curve （AUG） calculated to summarize and evaluate the diagnostic efficiency of CT and MRI in lumbar intervertebral disc herniation. Finally a sensitivity analysis was performed. Results According to the criteria of internalization, 9 articles were included. Among them, the themes were CT （ n = 3 ）, MRI （ n = 3 ） and CT ＆ MRI （ n = 3 ）. Eight was prospectively studied and one retrospectively. At the diagnosis of lumbar intervertebral disc herniation, the pooled weighted sensibility and specificity and 95% confidence interval and area under SROC curve for CT to the lumbar intervertebral disc herniation was 0. 73 （ 0. 68-0. 77 ）, 0. 78 （ 0. 72-0. 82 ） and 83.5%respectively. The MRI was 0. 88 （ 0. 83-0. 91 ）, 0. 79 （ 0. 71-0. 87 ） and 88. 8% respectively. There was statistically significant difference in the pooled weighted sensibility （ P 〈 0. 05 ）; No statistically significant difference was found in the pooled weighted specificity （ P 〉 0. 05 ）; And there was statistically significant difference in the AUG curve （ P 〈 0. 05 ）. Conclusion After a meta-analysis of the diagnostic value of CT and MRI for the lumbar intervertebral disc herniation, MRI is more accurate than CT in the diagnosis of lumbar intervertebral disc herniation.