Diagnostic accuracy and reliability of ultrasonography for the detection of fatty liver: a meta-analysis.
Diagnostic accuracy and reliability of ultrasonography for the detection of fatty liver: a meta-analysis.
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DOI：
10.1002/hep.24452
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发表时间：
2011-09-02
期刊：
影响因子：
13.5
通讯作者：
Clark, Jeanne M.
中科院分区：
文献类型：
--
作者：
Hernaez, Ruben;Lazo, Mariana;Bonekamp, Susanne;Kamel, Ihab;Brancati, Frederick L.;Guallar, Eliseo;Clark, Jeanne M.
超声检查是一种广泛使用的检测脂肪肝的成像技术，但报告的准确性和可靠性在研究中不一致。我们的目的是对超声诊断脂肪肝的准确性和可靠性进行系统评价和荟萃分析。我们从1967年10月至2010年3月使用MEDLINE和Embase。纳入了提供超声检查与组织学或标准成像技术的交叉表或提供超声检查可靠性数据的研究。研究变量由三名评审员独立提取，并由一名评审员进行双重检查。纳入了49项（4720名受试者）研究用于诊断准确性的荟萃分析。与组织学相比，超声检测中重度脂肪肝的总体灵敏度、特异性、阳性似然比和阴性似然比（金标准），分别为84.8%（95%置信区间：79.5-88.9），93.6%（87.2-97.0），13.3（6.4-27.6）和0.16（0.12-0.22）。总接收工作特性曲线下面积为0.93（0.91-0.95）。超声检测脂肪肝的信度显示，Kappa统计值的内部信度范围为0.54 - 0.92，评估者间信度范围为0.44 - 1.00。超声的灵敏度和特异性与其他成像技术相似（即，计算机断层摄影或磁共振成像）。即使在多个临床相关特征分层后，也存在统计学异质性。与组织学相比，超声检查可以可靠和准确地检测中重度脂肪肝。由于其低成本，安全性和可及性，超声可能是临床和人群中筛选脂肪肝的首选成像技术。
Ultrasonography is a widely accessible imaging technique for the detection of fatty liver, but the reported accuracy and reliability have been inconsistent across studies. We aimed to perform a systematic review and meta-analysis of the diagnostic accuracy and reliability of ultrasonography for the detection of fatty liver. We used MEDLINE and Embase from October 1967 to March 2010. Studies that provided cross-tabulations of ultrasonography versus histology or standard imaging techniques, or that provided reliability data for ultra-sonography, were included. Study variables were independently abstracted by three reviewers and double checked by one reviewer. Forty-nine (4720 participants) studies were included for the meta-analysis of diagnostic accuracy. The overall sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of ultrasound for the detection of moderate-severe fatty liver, compared to histology (gold standard), were 84.8% (95% confidence interval: 79.5-88.9), 93.6% (87.2-97.0), 13.3 (6.4-27.6), and 0.16 (0.12-0.22), respectively. The area under the summary receiving operating characteristics curve was 0.93 (0.91-0.95). Reliability of ultrasound for the detection of fatty liver showed kappa statistics ranging from 0.54 to 0.92 for intrarater reliability and from 0.44 to 1.00 for interrater reliability. Sensitivity and specificity of ultrasound was similar to that of other imaging techniques (i.e., computed tomography or magnetic resonance imaging). Statistical heterogeneity was present even after stratification for multiple clinically relevant characteristics. Ultrasonography allows for reliable and accurate detection of moderate-severe fatty liver, compared to histology. Because of its low cost, safety, and accessibility, ultrasound is likely the imaging technique of choice for screening for fatty liver in clinical and population settings.
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