Network Meta-Analysis: Noninvasive Imaging Modalities for Identifying Clinically Significant Portal Hypertension.
Network Meta-Analysis: Noninvasive Imaging Modalities for Identifying Clinically Significant Portal Hypertension.
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网络荟萃分析：识别临床显著门脉高压的非侵入性成像方式。
DOI：
10.1007/s10620-021-07168-y
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发表时间：
2022-07
影响因子：
3.1
通讯作者：
Forsberg F
中科院分区：
文献类型：
--
作者：
Hai Y;Chong W;Eisenbrey JR;Forsberg F
虽然肝静脉压力梯度（HVPG）的测量是目前获得门静脉压力的参考标准，几个非侵入性成像为基础的方式已被提出作为替代。我们进行了一项系统回顾和荟萃分析，以比较非侵入性成像方法识别临床显著门静脉高压症（CSPH）的诊断准确性。两名独立评审员对PubMed、SCOPUS和科克伦图书馆进行了文献检索，检索时间从开始到2021年1月5日。将以下成像模式与HVPG进行比较：计算机断层扫描（CT）、磁共振成像（MRI）、磁共振弹性成像（MRE）、超声、瞬态弹性成像（TE）、剪切波弹性成像（SWE）、声辐射力脉冲（ARFI）成像、对比增强超声（CEUS）和次谐波辅助压力估计（SHAPE）。使用频率随机效应和贝叶斯网络荟萃分析方法计算敏感性、特异性、诊断比值比（DOR）和总结受试者工作特征（SROC）的曲线下面积（AUC）。我们分析了45项研究5678例患者。在不同的成像模式中观察到DOR的广泛重叠置信区间（CI）：ARFI（30.5; 95% CI 12.7-73.3），CEUS和SHAPE（21.1; 95% CI 6.4-69.8），肝硬度TE（21.1; 95% CI 13.3-33.5）、CT和MRI（13.7; 95% CI 7.40-25.4）、肝脏硬度SWE（10.5; 95% CI 5.2-21.1）和超声（9.5; 95% CI 4.9-18.4）。所有成像方法的AUC均超过0.8，表明性能非常好。在80%特异性的临界值下，TE、CEUS和SHAPE的灵敏度超过80%。总的来说，非侵入性成像方式在识别CSPH方面表现良好。临床医生在诊断CSPH时应考虑这些非侵入性且具有成本效益的测试。
Although measurement of the hepatic venous pressure gradient (HVPG) is the current reference standard for obtaining portal venous pressures, several non-invasive imaging-based modalities have been proposed as alternatives. We performed a systematic review and meta-analysis to compare the diagnostic accuracy of non-invasive imaging approaches for identifying clinically significant portal hypertension (CSPH). Two independent reviewers conducted a literature search of PubMed, SCOPUS, and the Cochrane Library from inception until January 5th, 2021. The following imaging modalities were compared to HVPG: computed tomography (CT), magnetic resonance imaging (MRI), magnetic resonance elastography (MRE), ultrasound, transient elastography (TE), shear wave elastography (SWE), acoustic radiation force impulse (ARFI) imaging, contrast-enhanced ultrasound (CEUS), and subharmonic aided pressure estimation (SHAPE). Sensitivity, specificity, diagnostic odds ratio (DOR), and area under the curve (AUC) for summary receiver operating characteristic (SROC) were calculated using both frequentist random-effects and Bayesian network meta-analytic approaches. We analyzed 45 studies of 5678 patients. A broad overlapping confidence interval (CI) of DOR was observed among different imaging modalities: ARFI (30.5; 95% CI 12.7–73.3), CEUS and SHAPE (21.1; 95% CI 6.4–69.8), TE of liver stiffness (21.1; 95% CI 13.3–33.5), CT and MRI (13.7; 95% CI 7.40–25.4), SWE of liver stiffness (10.5; 95% CI 5.2–21.1), and ultrasound (9.5; 95% CI 4.9–18.4). The AUC of all imaging methods exceeded 0.8, indicating very good performance. At a cut-off of 80% specificity, TE, CEUS and SHAPE exceeded 80% sensitivity. Overall, non-invasive imaging modalities perform well for identifying CSPH. Clinicians should consider these non-invasive and cost-efficient tests when diagnosing CSPH.
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影响因子：
29.4
作者：
Huwart, Laurent;Sempoux, Christine;Van Beers, Bernard E.
通讯作者：
Van Beers, Bernard E.
影响因子：
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