【摘要】 目的系统评价超声造影与增强CT在肾脏肿瘤良恶性鉴别诊断中的临床价值。方法系统检索中国知网、万方、PubMed、Embase、Cochrane图书馆等数据库,检索时间为建库至2018年12月,收集有关超声造影与增强CT技术鉴别诊断同一组肾脏肿瘤良恶性的相关文献,严格按照纳入、排除标准进行文献筛查、数据提取及方法学质量评价。采用Stata 14.0软件计算两种检查方法诊断恶性肾脏肿瘤的敏感性、特异性、阳性似然比、阴性似然比、诊断比值比;绘制汇总受试者工作特征(SROC)曲线,计算曲线下面积,并探讨异质性的程度和潜在来源。结果共纳入了10项对照研究,共1290个病灶,超声造影与增强CT检测肾脏肿瘤的合并敏感性和合并特异性分别为0.95[95%可信区间(CI):0.93～0.96]和0.90(95%CI:0.85～0.93),0.75(95%CI:0.66～0.83)和0.72(95%CI:0.63～0.80),诊断比值比分别为59(95%CI:35～100)和27(95%CI:19～40),SROC曲线下面积分别为0.95(95%CI:0.93～0.97)和0.89(95%CI:0.86～0.91);两种检查方法仅诊断比值比比较差异有统计学意义(P<0.05)。超声造影与增强CT对≤4 cm的肾脏小肿瘤合并敏感性、特异性、诊断比值比分别为0.95(95%CI:0.92～0.97)和0.87(95%CI:0.82～0.92),0.76(95%CI:0.65～0.86)和0.75(95%CI:0.65～0.86),63(95%CI:34～116)和21(95%CI:10～46),SROC曲线下面积分别为0.95(95%CI:0.93～0.97)和0.90(95%CI:0.87～0.92),二者的敏感性、诊断比值比比较差异均有统计学意义(均P<0.05)。结论超声造影在肾脏肿瘤的诊断中,具有与增强CT相当的高敏感性和中等特异性;对于直径≤4 cm肾脏肿瘤,超声造影较增强CT的诊断敏感性更高。更多还原

【Abstract】 Objective To systematically and comparatively evaluate the clinical value of contrast-enhanced()Methods performed on the databases of CNKI,Wanfang,Pub Med,Embase,and Cochrane Library.The retrieval time was from databaseestablishment to December 2018.Relevant literatures on the differential diagnosis of benign and malignant kidney tumors in thesame group examined by CEUS and CECT were collected. Literature screening,data extraction and methodological qualityevaluation are in strict accordance with the inclusion and exclusion criteria.The sensitivity,specificity,positive likelihood ratio,negative likelihood ratio,and diagnostic odds ratio of the two methods for differential diagnosis between malignant renal tumorswas calculated with Stata 14.0 software.Summary receiver operating characteristic(SROC)curve was drawn and the area underthe curve was calculated,and the extent and potential sources of heterogeneity was discussed.ResultsA total of 10 controlledstudies with a total of 1290 lesions were included.The combined sensitivity and specificity of CEUS and CECT in detecting renaltumors were 0.95[95%CI:0.93～0.96]and 0.90(95%CI:0.85～0.93),0.75(95%CI:0.66～0.83)and 0.72(95%CI:0.63～0.80),respectively.The diagnostic odds ratios were 59(95%CI:35～100)and 27(95%CI:19 to 40),respectively,and the areas underthe ROC curve are 0.95(95%CI:0.93～0.97)and 0.89(95%CI:0.86～0.91),respectively. There was statistically significantdifference in the diagnostic odds ratio between the two methods(P<0.05).The sensitivity,specificity,and diagnostic odds ratio ofCEUS and CECT for renal tumors≤4 cm in diameter were 0.95(95%CI:0.92～0.97)and 0.87(95%CI:0.82～0.92),0.76(95%CI:0.65～0.86)and 0.75(95%CI:0.65～0.86),63(95%CI:34～116),and 21(95%CI:10～46).The areas under the SROC curve were0.95(95%CI:0.93～0.97)and 0.90(95%CI:0.87～0.92).The differences in sensitivity and diagnostic odds ratio were statisticallysignificant(both P<0.05).ConclusionCEUS has the same high sensitivity and moderate specificity as CECT in the diagnosisof renal tumors.CEUS is more sensitive than CECT in the diagnosis of renal tumors ≤4 cm in diameter.更多还原