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1、廣西醫(yī)科大學(xué)碩士學(xué)位論文超聲造影與增強(qiáng)CT診斷小肝癌價(jià)值的系統(tǒng)評(píng)價(jià)姓名:鄒良英中請(qǐng)學(xué)位級(jí)別:碩士專業(yè):影像醫(yī)學(xué)與核醫(yī)學(xué)指導(dǎo)教師:李智賢20100601超聲造影與增強(qiáng)CT診斷小肝癌價(jià)值的系統(tǒng)評(píng)價(jià)目的:評(píng)價(jià)超聲造影、增強(qiáng)CT診斷小肝癌的價(jià)值,了解納入研究偏倚產(chǎn)生的來源及文獻(xiàn)報(bào)告質(zhì)量。方法:全面檢索2009年12月以前國(guó)內(nèi)外公開發(fā)表的關(guān)于超聲造影與增強(qiáng)CT診斷小肝癌的文獻(xiàn),通過納入排除標(biāo)準(zhǔn)對(duì)文獻(xiàn)進(jìn)行篩選,利用QUADAS(qualityassessmentofdiagnosticaccuracystudies)量表的評(píng)價(jià)標(biāo)準(zhǔn)對(duì)符合納入標(biāo)準(zhǔn)的文獻(xiàn)進(jìn)行質(zhì)量評(píng)價(jià),用Metadisc軟件對(duì)納入
2、文獻(xiàn)提取的數(shù)據(jù)進(jìn)行異質(zhì)性檢驗(yàn)和合并,并繪制SROC曲線,分析兩種檢測(cè)方法有無統(tǒng)計(jì)學(xué)差異。結(jié)果:共納入10篇文獻(xiàn),總例數(shù)740例,其中中文文獻(xiàn)1篇,英文文獻(xiàn)9篇。納入文獻(xiàn)主要存在多重參照偏倚.金標(biāo)準(zhǔn)解讀偏倚和臨床解讀偏倚。統(tǒng)計(jì)分析中,納入文獻(xiàn)中超聲造彩與增強(qiáng)CT及超聲造影聯(lián)合增強(qiáng)CT診斷小肝癌的合并敏感度及95%可信區(qū)間分別是0.80(0.76-0.84).0.77(0.72-0.82).0.92(0.87-0.95),合并特異度及95%可信區(qū)間分別是0.86(0.81-0.90),0.86(0.81-0.90)^0.79(0.70-0.86),SROC曲線下面積分別為0.9222
3、、0.9209、0.9199,超聲造影、增強(qiáng)CT與兩者聯(lián)合診斷小肝癌準(zhǔn)確性無統(tǒng)計(jì)學(xué)差異。結(jié)論:納入文獻(xiàn)較好的控制了偏倚;在小肝癌影像學(xué)診斷方法中,超聲造影與增強(qiáng)CT診斷準(zhǔn)確性具有高度一致性。關(guān)鍵詞肝細(xì)胞癌,診斷性試驗(yàn),質(zhì)量評(píng)價(jià),系統(tǒng)評(píng)價(jià)DIAGNOSISVALUEOFCONTRAST-ENHANCEDULTRASOUNDANDCONTRAST-ENHANCEDCOMPUTEDTOMOGRAPHYFORSMALLHEPATOCELLULARCARCI-NOMA:ASYSTEMATICREVIEWABSTRACTObjective:"assesstheaccuracyofContr
4、ast-EnhancedultrasoondandContrast-Enhancedcomputedtomgraphyindiagnosingsmallhepatocellularcarcinoma;ToevaluatethequalityofthecurrentstudiesinvolvingthevalueofContrast-EnhancedUltrasoundandContrast-Enhancedcomputedtomgraphyindiagnosingsmallhepatocellularcarcinomaandanalysethesourcesofbias.Meth
5、ods:AccordingtoCochraneCollaborationsearchingstrategyfordiagnostictests,WecomprehensivecollectedcurrentstudiesaboutContrast-EnhancedultrasoundandContrast-Enhancedcomputedtomgraphydiagnosinghepatocellularcarcinomasbyelectronicretrieval,supplementedbymanuallyretrievaltherelevantjoumals.QUADASit
6、emswereusedforqualityassessmentinoursystematicreview.Metadiscsoftwarewasusedtoanalysesensitvit-y,specifictyanddrawSROCcurves.Results:Totallytenstudieswereincluded.Thetotalnumberofcaseis74O.Becauseofmanykindsofreferencestandard,therehasariskofbias.Theweightedsensitivityand95%CIoftheenrolledlit
7、eratureaboutcontrast-enhancedultrasound,Contrast-Enhancedcomputedtomgraphy,contrast-enhaneedultrasoundandContrast-Enhancedcomputedtomgraphyindiagnosingsmallhepatocellularcarcinomawere0.80(0.76-0.84),0.77(0.72-0.82),0.92(0.87-0.95)respectively