背景:肝细胞癌是最常见的原发性肝脏恶性肿瘤。从以前的研究结果来看,肝脏影像报告和数据系统(LI-RADS)在超声造影(CEUS)上显示出令人满意的诊断价值。然而,关于这种创新的超声成像的观察者间稳定性的统一结论尚未确定。本荟萃分析考察了CEUSLI-RADS的观察者间一致性,为后续相关研究提供参考。
目的:评估LI-RADS对CEUS的观察者间一致性,并分析研究之间异质性的来源。
方法:分析了2020年3月1日前在中国和其他国家发表的关于CEUSLI-RADS观察员协议的相关论文。这些研究经过过滤,并对诊断标准进行评价。使用R软件版本3.6.2的\"meta\"和\"metafor\"软件包分析所选择的参考文献。
结果:本分析最终纳入了8项研究。Meta分析结果显示,纳入研究的Kappa值汇总为0.76[95%置信区间,0.67-0.83],这表明了实质性的协议。希金斯I2统计也证实了实质性的异质性(I2=91.30%,95%置信区间,85.3%-94.9%,P<0.01)。元回归确定了变量,包括患者登记的方法,一致性测试方法,和耐心的种族,这解释了研究的实质性异质性。
结论:CEUSLI-RADS展示了总体上实质性的观察者间协议,但研究之间的异质性结果也很明显。进一步的临床研究应考虑有关实验设计的修改建议。
BACKGROUND: Hepatocellular carcinoma is the most common primary liver malignancy. From the results of previous studies, Liver Imaging Reporting and Data System (LI-RADS) on contrast-enhanced ultrasound (CEUS) has shown satisfactory diagnostic value. However, a unified conclusion on the interobserver stability of this innovative ultrasound imaging has not been determined. The present meta-analysis examined the interobserver agreement of CEUS LI-RADS to provide some reference for subsequent related research.
OBJECTIVE: To evaluate the interobserver agreement of LI-RADS on CEUS and analyze the sources of heterogeneity between studies.
METHODS: Relevant papers on the subject of interobserver agreement on CEUS LI-RADS published before March 1, 2020 in China and other countries were analyzed. The studies were filtered, and the diagnostic criteria were evaluated. The selected references were analyzed using the \"meta\" and \"metafor\" packages of R software version 3.6.2.
RESULTS: Eight studies were ultimately included in the present analysis. Meta-analysis results revealed that the summary Kappa value of included studies was 0.76 [95% confidence interval, 0.67-0.83], which shows substantial agreement. Higgins I 2 statistics also confirmed the substantial heterogeneity (I 2 = 91.30%, 95% confidence interval, 85.3%-94.9%, P < 0.01). Meta-regression identified the variables, including the method of patient enrollment, method of consistency testing, and patient race, which explained the substantial study heterogeneity.
CONCLUSIONS: CEUS LI-RADS demonstrated overall substantial interobserver agreement, but heterogeneous results between studies were also obvious. Further clinical investigations should consider a modified recommendation about the experimental design.