The diagnostic performance of MRI in osteoarthritis: a systematic review and meta-analysis.
The diagnostic performance of MRI in osteoarthritis: a systematic review and meta-analysis.
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DOI：
10.1016/j.joca.2011.10.003
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发表时间：
2012-01
影响因子：
7
通讯作者：
Hunter, D. J.
中科院分区：
文献类型：
--
作者：
Menashe, L.;Hirko, K.;Losina, E.;Kloppenburg, M.;Zhang, W.;Li, L.;Hunter, D. J.
骨关节炎（OA）目前诊断使用临床和影像学表现。近年来，越来越多地研究MRI在骨关节炎中的应用。本研究旨在通过对已发表研究的荟萃分析，确定MRI在OA中的诊断效用。进行了系统性文献检索，以纳入使用MRI评价或检测骨关节炎的研究。将MRI与各种参考标准进行比较：组织学、关节镜检查、X线摄影、CT、临床评价和直接目视检查。计算敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）和受试者工作特征（ROC）曲线下面积。使用随机效应模型来汇总结果。在从文献中识别的20项相关研究中，16项报告了完整的数据，并纳入荟萃分析，共1220例患者（1071例OA患者和149例非OA患者）。所有纳入研究汇总数据的总体灵敏度为61%（95%置信区间[CI] 53 - 68），特异性为82%（95% CI 77 - 87），PPV为85%（95% CI 80 - 88），NPV为57%（95% CI 43 - 70）。ROC曲线下的面积为0.804。上述参数存在显著异质性（I2 >83%）。以组织学为参考标准，与所有参考标准相比，灵敏度增加到74%，特异性降低到76%。当关节镜作为参考标准时，与所有参考标准相结合相比，敏感性增加到69%，特异性增加到93%。与各种参考标准相比，MRI可以检测出具有总体高特异性和中等灵敏度的OA，因此排除OA比排除OA更有用。MRI的敏感性低于目前的临床诊断标准。目前，在X线片辅助下的OA诊断标准临床算法似乎是诊断OA的最有效方法。
Osteoarthritis (OA) is currently diagnosed using clinical and radiographic findings. In recent years MRI use in osteoarthritis has increasingly been studied. This study was conducted to determine the diagnostic utility of MRI in OA through a meta-analysis of published studies. A systematic literature search was undertaken to include studies that used MRI to evaluate or detect osteoarthritis. MRI was compared to various reference standards: histology, arthroscopy, radiography, CT, clinical evaluation, and direct visual inspection. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and receiver operating characteristic (ROC) area under the curve were calculated. Random effects models were used to pool results. Of 20 relevant studies identified from the literature, 16 reported complete data and were included in the meta-analysis, with a total of 1220 patients (1071 with OA and 149 without). Overall sensitivity from pooling data of all the included studies was 61% (95% confidence interval [CI] 53 to 68), specificity was 82% (95% CI 77 to 87), PPV was 85% (95% CI 80 to 88), and NPV was 57% (95% CI 43 to 70). The ROC showed an area under the curve of 0.804. There was significant heterogeneity in the above parameters (I2 >83%). With histology as the reference standard, sensitivity increased to 74% and specificity decreased to 76% compared with all reference standards combined. When arthroscopy was used as the reference standard, sensitivity increased to 69% and specificity to 93% compared with all reference standards combined. MRI can detect OA with an overall high specificity and moderate sensitivity when compared with various reference standards, thus lending more utility to ruling out OA than ruling it in. The sensitivity of MRI is below the current clinical diagnostic standards. At this time standard clinical algorithm for OA diagnosis, aided by radiographs appears to be the most effective method for diagnosing OA.
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影响因子：
19.7
作者：
RECHT, MP;KRAMER, J;RESNICK, D
通讯作者：
RESNICK, D
影响因子：
19.7
作者：
Kijowski, Richard;Blankenbaker, Donna G.;De Smet, Arthur A.
通讯作者：
De Smet, Arthur A.
影响因子：
6.3
作者：
Downs, SH;Black, N
通讯作者：
Black, N
影响因子：
19.7
作者：
HODLER, J;HAGHIGHI, P;RESNICK, D
通讯作者：
RESNICK, D
DOI：
10.1016/0197-2456(86)90046-2
发表时间：
1986-09-01
期刊：
CONTROLLED CLINICAL TRIALS
影响因子：
--
作者：
DERSIMONIAN, R;LAIRD, N
通讯作者：
LAIRD, N