目的:本荟萃分析旨在评估计算机断层扫描(CT)对胃食管静脉曲张(GEVs)的诊断准确性,并确定肝硬化患者的高危GEVs。
方法:对数据库的全面搜索确定了28项报告通过内窥镜检查确认的基于CT的GEV诊断的研究。进行Meta分析以计算合并敏感性(SEN)和合并特异性(SPE)。正似然比(PLR)和负似然比(NLR),诊断优势比(DOR),和曲线下面积(AUC)。
结果:根据患者(或静脉曲张)的数量,汇集的SEN,SPE,PLR,NLR,DOR,基于CT诊断的AUC估计为0.91(0.92),0.81(0.45),4.82(1.67),0.11(0.17),42.47(10.26),和0.93(0.94),分别,对于任何GEV和0.89(0.89),0.90(0.79),8.86(4.28),0.12(0.14),75.71(30.19),和0.95(0.85),分别,用于高风险GEV。亚组分析表明,与胃静脉曲张相比,CT对食管静脉曲张的诊断准确性更高(AUC:0.93vs.0.89,P<0.05),与16层和<16层CT相比,64层CT的SEN更高(AUC:0.97vs.分别为0.92和0.82,P<0.05)。前瞻性研究显示诊断准确性高于回顾性研究(AUC:0.95vs.0.90,P<0.05)。关于静脉曲张大小,区分低风险和高风险个体的3毫米和5毫米的界限,分别,具有较高的诊断准确性(AUC:0.992vs.0.997,P>0.05)。
结论:CT显示了在肝硬化患者中识别GEVs和区分高风险GEVs的有希望的诊断准确性。有必要进一步研究验证最佳静脉曲张大小截止值,以提高临床实用性。
结论:如此高的CT扫描对预测静脉曲张的诊断准确性对于肝硬化合并门脉高压患者具有临床意义。如果CT扫描发现高危静脉曲张,早期干预有助于降低静脉曲张破裂出血的风险。
OBJECTIVE: This meta-analysis aimed to evaluate the diagnostic accuracy of computed tomography (CT) for gastroesophageal varices (GEVs) and identify high-risk GEVs in patients with cirrhosis.
METHODS: A comprehensive search of databases identified 28 studies reporting on CT-based diagnosis for GEVs confirmed via endoscopy. Meta-analyses were conducted to calculate the pooled sensitivity (SEN) and pooled specificity (SPE), positive likelihood ratio (PLR) and negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and the area under the curve (AUC).
RESULTS: Based on the number of patients (or varices), the pooled SEN, SPE, PLR, NLR, DOR, and AUC of CT-based diagnosis were estimated at 0.91 (0.92), 0.81 (0.45), 4.82 (1.67), 0.11 (0.17), 42.47 (10.26), and 0.93 (0.94), respectively, for any GEV and at 0.89 (0.89), 0.90 (0.79), 8.86 (4.28), 0.12 (0.14), 75.71 (30.19), and 0.95 (0.85), respectively, for high-risk GEVs. Subgroup analyses indicated that CT had a higher diagnostic accuracy for esophageal varices compared with gastric varices (AUC: 0.93 vs. 0.89, P < 0.05), and the 64-slice CT yielded superior SEN compared with 16-slice and <16-slice CT (AUC: 0.97 vs. 0.92 and 0.82, respectively, P < 0.05). Prospective studies demonstrated higher diagnostic accuracy than retrospective studies (AUC: 0.95 vs. 0.90, P < 0.05). Regarding variceal size, a cut-off of 3 mm and 5 mm discriminated between low- and high-risk individuals, respectively, with high diagnostic accuracy (AUC: 0.992 vs. 0.997, P > 0.05).
CONCLUSIONS: CT demonstrates promising diagnostic accuracy for identifying GEVs and distinguishing high-risk GEVs in patients with cirrhosis. Further research validating optimal variceal size cut-offs is warranted to enhance clinical utility.
CONCLUSIONS: Such a high diagnostic accuracy of CT scans for predicting varices is clinically meaningful for patients with cirrhosis accompanied by portal hypertension. If high-risk varices are identified at CT scans, early intervention would be helpful to reduce the risk of variceal bleeding.