CT肺动脉造影与肺灌注断层显像对肺栓塞诊断价值的Meta分析

Computed tomographic pulmonary angiography versus single photon emission computed tomography in diagnosing of pulmonary embolism:a Meta-analysis

目的对研究CT肺动脉造影(computed tomographic pulmonary angiography,CTPA)和单光子发射计算机断层成像术(single-photon emission computed tomography,SPECT)诊断肺动脉栓塞(pulmonary embolism,PE)的文献进行Meta汇总分析,评价两者对肺栓塞的临床诊断价值。方法检索1990年1月至2012年1月在Pubmed、Ovid数据库和中国期刊网中关于CTPA和SPECT显像的文献,应用Meta-Disc软件分别汇总两者的敏感度和特异度及其95%可信区间。根据汇总受试者工作特征曲线(summary receiver operating characteristic,SROC),计算曲线下面积(areas under curve,AUC),得出各自的Q*值,评价两种方法的诊断效能。结果共有16篇文献符合纳入标准。CTPA汇总敏感度和特异度分别为0.79(0.75,0.83)和0.90(0.87,0.93),SPECT显像的汇总敏感度和特异度为0.86(0.78,0.93)和0.95(0.92,0.98)。两者的SROC曲线下面积分别为93.72%和97.64%。两者的Q*值分别为0.8740和0.9306。比较两者Q*值,CTPA与SPECT显像差异无统计学意义(P>0.05)。结论CTPA与SPECT显像在诊断肺栓塞方面均具有较高的诊断准确性,两者比较差异无统计学意义。

Objective To perform a Meta-analysis to evaluate the overall diagnostic value of computed tomography pulmonary angiography（CTPA）and single photon emission computed tomography（SPECT）in patients with suspected pulmonary embolism. Methods A literature search in PubMed,Ovid,and CNKI （China National Knowledge Infrastructure） was performed to identify relevant English and Chinese articles from 1990 to 2012. The Meta-Disc software was used to calculate the pooled sensitivity,specificity and the corresponding 95% CI. Summary receiver operating characteristic（SROC）curves,areas under curve（AUC）and the Q＊ index were calculated and used to evaluate the diagnostic efficiency of the two methods. Results Totally sixteen articles met our inclusion criteria. The pooled weighted sensitivity and specificity for CTPA and SPECT scanning were 0.79/0.90 and 0.86/0.95. The AUC of SROC for the two methods were 93.72% and 97.64%,and the Q＊ index estimates were 0.8740 and 0.9306,respectively. Comparing the Q＊ index of CTPA and SPECT,there was no statistically significant difference between the two methods（P〉0.05）. Conclusion Both CTPA and SPECT have good diagnostic performance in the diagnosis of pulmonary embolism. There was no significant difference between the two methods.