Acute appendicitis: Meta-analysis of diagnostic performance of CT and graded compression US related to prevalence of disease
Acute appendicitis: Meta-analysis of diagnostic performance of CT and graded compression US related to prevalence of disease
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DOI：
10.1148/radiol.2483071652
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发表时间：
2008-10-01
期刊：
影响因子：
19.7
通讯作者：
Boermeester, Marja A.
中科院分区：
文献类型：
--
作者：
van Randen, Adrienne;Bipat, Shandra;Boermeester, Marja A.
目的：本研究是一个头对头的比较分级压缩超声（US）和计算机断层扫描（CT）在帮助诊断急性阑尾炎的诊断价值，强调在不同的疾病患病率，通常发生在各种医院settings.Materials和方法：MEDLINE，EMBASE，CINAHL，和科克伦数据库进行了检索，从1966年1月至2006年2月。如果前瞻性试验（a）在相同患者人群中比较了分级压缩US和CT;（B）纳入了10例以上患者，否则，该研究被视为病例报告;（c）主要评价成人或青少年;（d）使用手术和/或临床随访作为参考标准;（e）报告的数据用于计算分级压缩US和CT的2 x 2列联表，则选择前瞻性试验。计算US和CT的敏感性、特异性以及阳性和阴性似然比（LR）。CT和US后测概率计算各种临床相关prevalences.Results：六项研究，评估671例（平均年龄范围，26-38岁）;急性阑尾炎的患病率为50%（范围，13%-77%）。CT的阳性LR为9.29（95%置信区间[CI]：6.9，12.6），US为4.50（95% CI：3.0，6.7; P = .011），阳性检测的验后概率分别为90%和82%。CT和US的阴性LR分别为0.10（95% CI：0.06，0.17）和0.27（95% CI：0.17，0.43）（P = 0.013），导致后测概率分别为9%和21%。阳性测试的验后概率显着下降，在较低的prevalences.Conclusion：在头对头诊断成像比较研究，CT有一个更好的测试性能比分级压缩US诊断阑尾炎。忽略患病率（预测试概率）和诊断价值之间的关系可能会导致诊断性能的不准确估计。(C)RSNA，2008年。
Purpose: This study was a head-to-head comparison of graded compression ultrasonography (US) and computed tomography (CT) in helping diagnose acute appendicitis with an emphasis on diagnostic value at different disease prevalences, commonly occurring in various hospital settings.Materials and Methods: MEDLINE, EMBASE, CINAHL, and Cochrane databases were searched from January 1966 to February 2006. Prospective trials were selected if they (a) compared graded compression US and CT in the same patient population; (b) included more than 10 patients, otherwise, the study was considered a case report; (c) evaluated mainly adults or adolescents; (d) used surgery and/or clinical follow-up as reference standard; and (e) reported data to calculate 2 x 2 contingency tables for graded compression US and CT. Estimates of sensitivity, specificity, and positive and negative likelihood ratios (LRs) for US and CT were calculated. Posttest probabilities after CT and US were calculated for various clinically relevant prevalences.Results: Six studies were included, evaluating 671 patients (mean age range, 26-38 years); prevalence of acute appendicitis was 50% (range, 13%-77%). Positive LR was 9.29 (95% confidence interval [CI]: 6.9, 12.6) for CT and 4.50 (95% CI: 3.0, 6.7; P = .011) for US, yielding posttest probabilities for positive tests of 90% and 82%, respectively. Negative LR was 0.10 (95% CI: 0.06, 0.17) for CT and 0.27 (95% CI: 0.17, 0.43) for US (P = .013), resulting in posttest probabilities of 9% and 21%, respectively. Posttest probabilities for positive tests were markedly decreased at lower prevalences.Conclusion: In head-to-head comparison studies of diagnostic imaging, CT had a better test performance than did graded compression US in diagnosing appendicitis. Ignoring the relationship between prevalence (pretest probability) and diagnostic value may lead to an inaccurate estimation of diagnostic performance. (C) RSNA, 2008.