Diagnostic value of CT contrast extravasation for major arterial injury after pelvic fracture: A meta-analysis
Diagnostic value of CT contrast extravasation for major arterial injury after pelvic fracture: A meta-analysis
复制标题
CT造影剂外渗对骨盆骨折后大动脉损伤的诊断价值：荟萃分析
DOI：
10.1016/j.ajem.2019.11.038
复制
发表时间：
2020-11-01
影响因子：
3.6
通讯作者：
Scalea, Thomas M.
中科院分区：
文献类型：
--
作者：
Dreizin, David;Liang, Yuanyuan;Scalea, Thomas M.
目的：我们进行了一项荟萃分析，以确定CT静脉造影剂外渗（CE）作为骨盆骨折后血管造影出血迹象以及血管栓塞需求的诊断效能。
材料和方法：一项结合造影剂外渗、骨盆创伤和CT概念的系统性文献检索，得到206项可能符合条件的研究。23项研究提供了准确性数据或足够的描述性数据，可构建2×2列联表，并为荟萃分析提供了3855名患者。使用QUADAS - 2工具评估方法学质量。使用双变量混合效应逻辑回归综合敏感度和特异度。使用I²统计量评估异质性。探索的异质性来源包括扫描仪的代别（64排CT与较低探测器排数）以及多期与单期扫描方案的使用。
结果：总体敏感度和特异度分别为80%（95%置信区间：66 - 90%，I² = 92.65%）和93%（置信区间：90 - 96，I² = 89.34%）。亚组分析显示，64排CT的合并敏感度和特异度分别为94%和89%，而较旧代扫描仪分别为69%和95%。使用多期方案时，CE的合并敏感度和特异度为95%和92%，而单期方案分别为74%和94%。
结论：64排CT的合并敏感度和特异度为94%和89%。64排CT提高了CE的敏感度，使用较低探测器排数扫描仪时敏感度为69%。通过采用多期扫描方案可保持较高的特异度（92%）。（C）2019爱思唯尔公司。保留所有权利。
Purpose: We conducted a meta-analysis to determine diagnostic performance of CT intravenous contrast extravasation (CE) as a sign of angiographic bleeding and need for angioembolization after pelvic fractures.Materials and methods: A systematic literature search combining the concepts of contrast extravasation, pelvic trauma, and CT yielded 206 potentially eligible studies. 23 studies provided accuracy data or sufficient descriptive data to allow 2x2 contingency table construction and provided 3855 patients for meta-analysis. Methodologic quality was assessed using the QUADAS-2 tool. Sensitivity and specificity were synthesized using bivariate mixed-effects logistic regression. Heterogeneity was assessed using the I2-statistic. Sources of heterogeneity explored included generation of scanner (64 row CT versus lower detector row) and use of multiphasic versus single phase scanning protocols.Results: Overall sensitivity and specificity were 80% (95% CI: 66-90%, I2 = 92.65%) and 93% (CI: 90-96, I2 = 89.34%), respectively. Subgroup analysis showed pooled sensitivity and specificity of 94% and 89% for 64- row CT compared to 69% and 95% with older generation scanners. CE had pooled sensitivity and specificity of 95% and 92% with the use of multiphasic protocols, compared to 74% and 94% with single-phase protocols.Conclusion: The pooled sensitivity and specificity of 64-row CT was 94 and 89%. 64 row CT improves sensitivity of CE, which was 69% using lower detector row scanners. High specificity (92%) can be maintained by incorporating multiphasic scan protocols. (C) 2019 Elsevier Inc. All rights reserved.