背景:这项荟萃分析评估了双能计算机断层扫描(DECT)在诊断前交叉韧带(ACL)损伤中的功效。
方法:文献检索一直进行到2023年12月8日,包括对几个数据库的全面检查:PubMed,Embase,科克伦图书馆,WebofScience,中国国家知识基础设施(CNKI),万方,和VIP。诊断指标敏感度,特异性,正似然比(PLR),负似然比(NLR),诊断优势比(DOR),并使用双变量模型分析确定综合接受者工作特征(SROC)。通过亚组分析探索数据内部的异质性,考虑了包括地理区域在内的变量,使用磁共振成像(MRI),关节镜,和研究设计。
结果:分析包括10项研究,包括544名患者。DECT对膝关节ACL损伤表现出实质性的诊断作用,灵敏度为0.91(95%置信区间[CI]:0.88-0.94),特异性为0.90(95%CI:0.81-0.95),PLR为9.20(95%CI:4.50-19.00),NLR为0.10(95%CI:0.06-0.14),DOR为97.00(95%CI:35.00-268.00),曲线下面积(AUC)为0.95(95%CI:0.93-0.97)。亚组分析一致显示,亚洲人群ACL损伤的诊断精度较高(敏感性:0.91,特异性:0.91,PLR:9.90,NLR:0.09,DOR:105.00,AUC:0.96),在MRI亚组中(敏感性:0.85,特异性:0.94,PLR:9.57,NLR:0.18,DOR:56.00,AUC:0.93),在关节镜亚组(灵敏度:0.92,特异性:0.89,PLR:8.40,NLR:0.09,DOR:94.00,AUC:0.95),对于前瞻性研究(敏感性:0.92,特异性:0.88,PLR:7.40,NLR:0.09,DOR:78.00,AUC:0.95),和回顾性研究(敏感性:0.91,特异性:0.93,AUC:0.93)。
结论:DECT在诊断ACL损伤中具有很高的价值。DECT的重要诊断价值为临床医生提供了强大的工具,可以提高诊断的准确性和效率,并优化患者管理和治疗结果。
BACKGROUND: This meta-analysis assessed the efficacy of dual-energy computed tomography (DECT) in the diagnosis of anterior cruciate ligament (ACL) injuries.
METHODS: The literature search was performed up to December 8, 2023, and included a comprehensive examination of several databases: PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang, and VIP. Diagnostic metrics sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and a summary receiver operating characteristic (SROC) were determined using a bivariate model analysis. Heterogeneity within the data was explored through subgroup analyses, which considered variables including geographical region, use of magnetic resonance imaging (MRI), arthroscopy, and study design.
RESULTS: The analysis included ten studies encompassing 544 patients. DECT demonstrated substantial diagnostic utility for ACL injuries of the knee, with a sensitivity of 0.91 (95% confidence interval [CI]: 0.88-0.94), a specificity of 0.90 (95% CI: 0.81-0.95), a PLR of 9.20 (95% CI: 4.50-19.00), a NLR of 0.10 (95% CI: 0.06-0.14), a DOR of 97.00 (95% CI: 35.00-268.00), and an area under the curve (AUC) of 0.95 (95% CI: 0.93-0.97). The subgroup analyses consistently showed high diagnostic precision for ACL injuries across Asian population (sensitivity: 0.91, specificity: 0.91, PLR: 9.90, NLR: 0.09, DOR: 105.00, AUC: 0.96), in MRI subgroup (sensitivity: 0.85, specificity: 0.94, PLR: 9.57, NLR: 0.18, DOR: 56.00, AUC: 0.93), in arthroscopy subgroup (sensitivity: 0.92, specificity: 0.89, PLR: 8.40, NLR: 0.09, DOR: 94.00, AUC: 0.95), for prospective studies (sensitivity: 0.92, specificity: 0.88, PLR: 7.40, NLR: 0.09, DOR: 78.00, AUC: 0.95), and for retrospective studies (sensitivity: 0.91, specificity: 0.93, AUC: 0.93).
CONCLUSIONS: DECT exhibits a high value in diagnosing ACL injuries. The significant diagnostic value of DECT provides clinicians with a powerful tool that enhances the accuracy and efficiency of diagnosis and optimizes patient management and treatment outcomes.