磁共振动态磁敏感对比增强鉴别胶质瘤复发与放射性坏死的荟萃分析

目的采用荟萃分析来评估磁共振动态磁敏感对比增强(dynamic susceptibility weighted contrast enhanced,DSC),鉴别胶质瘤复发与放射性坏死的诊断价值。材料与方法检索Pub Med、Embase、Web of Knowledge、Cochrane Libraries数据库,检索时间限定到2016年6月为止,语种限定为英文和中文,采用Meta-disc软件进行数据分析。结果共有9篇文献纳入本研究,包括251例患者和270个病灶,DSC鉴别放射性坏死与肿瘤复发的敏感性、特异性、阳性似然比、阴性似然比分别为0.88(95%CI:0.82~0.93)、0.85(95%CI:0.77~0.91)、4.47(95%CI:2.9~6.91;I~2=0,P0.001)、0.15(95%CI:0.10~0.23;I~2=0,P0.001)。诊断优势比(diagnostic odds ratio,DOR)为33(95%CI:15.86~68.66),DSC的受试者工作特征曲线下面积为0.94,Q*指数为0.873。DOR的I~2=0,代表9篇研究之间异质性很小。结论本荟萃分析证明不仅磁共振相对脑血容量值可以有效鉴别胶质瘤复发与放射性坏死,而且DSC具有较高的敏感性和特异性。     

动脉血流峰值流速变异度评价危重症患者容量反应状态的Meta分析

目的应用Meta分析系统评价不同动脉血流峰值流速变异度(ΔVpeak)评估危重症患者容量反应状态的临床价值。方法检索PubMed、Embase、Medline、Cochrane Library、CBMdisc、万方数据库、中国知网及维普数据库,由两名检索员搜集关于床旁超声测量动脉ΔVpeak诊断危重症患者容量反应性的相关文献,依据纳入和排除标准对建库至2019年5月的相关文献进行筛选,对纳入文献进行质量评价和资料提取,质量评价标准为QUADAS条目,对符合质量标准的文献采用Stata 15.0软件进行分析,计算床旁超声测量动脉ΔVpeak诊断危重症患者容量反应性的合并敏感性、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;绘制漏斗图评估纳入文献是否存在发表偏倚。结果本研究共纳入15篇文献,肱动脉、颈动脉、主动脉及其联合的ΔVpeak诊断危重症患者容量反应性的合并敏感性分别为0.71(95%CI:0.63~0.78)、0.87(95%CI:0.77~0.93)、0.83(95%CI:0.74~0.91)、0.79(95%CI:0.74~0.83);合并特异性分别为0.85(95%CI:0.78~0.90)、0.85(95%CI:0.76~0.91)、0.84(95%CI:0.73~0.91)、0.85(95%CI:0.81~0.89);阳性似然比分别为4.7(95%CI:3.1~7.0)、5.8(95%CI:3.5~9.5)、5.1(95%CI:2.9~8.8)、5.3(95%CI:4.1~6.9);阴性似然比分别为0.34(95%CI:0.26~0.44)、0.16(95%CI:0.09~0.27)、0.21(95%CI:0.13~0.32)、0.25(95%CI:0.20~0.31);诊断比值比分别为13.63(7.57~24.54)、41.04(19.13~88.02)、21.99(10.49~46.11)、21.87(14.33~31.31);曲线下面积分别为0.86(95%CI:0.82~0.88)、0.92(95%CI:0.90~0.94)、0.89(95%CI:0.86~0.91)、0.89(95%CI:0.86~0.92)。漏斗图结果表明肱动脉、颈动脉、主动脉及其联合的纳入文献均无发表偏倚。结论ΔVpeak可用于评估危重症患者的容量反应性,其中颈动脉ΔVpeak诊断价值最高。     

循环微小RNA对活动性结核病诊断效能的荟萃分析

目的用荟萃(meta)分析评价循环微小RNA对活动性结核病的诊断效能。方法检索PubMed、Web of Science、Embase、中国知网、万方、维普及中国生物医学文献数据库(CBM)等数据库收集文献,检索时限均为从建库至2019年4月。并根据文献中的原始资料评价循环miRNA检测活动性结核病的准确性,采用Stata 15.0软件进行meta分析。结果共纳入21篇文献,累计1142例患者和1231例对照者。meta分析结果显示合并敏感性为0.85(95%CI:0.78~0.89)、特异性为0.85(95%CI:0.81~0.88)、阳性似然比为5.49(95%CI:4.21~7.15)、阴性似然比为0.18(95%CI:0.13~0.26)、合并诊断比值比为30.06(95%CI:16.88~53.52),SROC曲线下面积(AUC)为0.91(95%CI:0.88~0.93)。亚组分析显示,miRNA-155用于诊断活动性结核病的AUC为0.90(95%CI:0.87~0.92)。结论循环miRNA是诊断活动性结核病的重要生物标志物,有较高敏感性和特异性。     

超声造影与增强CT对肾脏肿瘤诊断价值的Meta分析

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。     

超声弹性成像对颈部淋巴结良恶性鉴别诊断的Meta分析

目的应用Meta分析系统评价超声弹性成像鉴别诊断颈部淋巴结良恶性的价值。方法计算机检索Cochrane图书馆、PubMed、Embase、中国知网、万方、维普、中国生物医学文献数据库,搜索超声弹性成像鉴别诊断颈部淋巴结良恶性的相关文献,检索语言为英文和中文,检索时间为建库至2019年2月28日。对纳入文献进行异质性检验,并采用QUADAS量表进行质量评价。分析超声弹性成像鉴别诊断颈部恶性淋巴结的合并敏感性、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。结果最终纳入11篇文献,其中8篇中文文献,3篇英文文献,包括1134例患者,共1373个淋巴结。QUADAS量表评价显示,纳入文献质量较高。超声弹性成像鉴别诊断颈部恶性淋巴结的合并敏感性、特异性、阳性似然比、阴性似然比、诊断比值比分别为0.85(95%CI:0.83～0.87)、0.72(95%CI:0.68～0.76)、3.54(95%CI:2.19～5.71)、0.20(95%CI:0.13～0.32)、19.96(95%CI:8.85～45.04),SROC曲线下面积为0.9061。结论超声弹性成像对颈部淋巴结良恶性的鉴别诊断具有较高价值。     

PET/CT心肌灌注显像联合冠状动脉CTA诊断冠心病

目的 评价PET/CT心肌灌注显像(MPI)联合冠状动脉CTA(CTCA)诊断冠心病的准确性。方法 检索2001-2011年有关PET/CTCA诊断冠心病的原始研究,经过质量评价后对符合纳入标准的文献进行数据提取,并行Meta分析和亚组分析,绘制森林图和拟合ROC曲线。结果 纳入6篇文献(252例),按照随机效应模型合并后,MPI/CTCA、单独MPI和单独CTCA(段)的诊断敏感度(SEN)、特异度(SPE)、阳性预测值(PPV)、阴性预测值(NPV)、诊断比值比(DOR)、诊断准确率(ACC)及曲线下面积(AUC)分别为0.91(95%CI 0.84~0.96)、0.91(95%CI 0.84~0.96)和0.87(95%CI 0.80~0.92),0.99(95%CI 0.96~1.00)、0.91(95%CI 0.84~0.96)和0.91(95%CI 0.88~0.94),0.95(95%CI 0.82~1.00)、0.94(0.86~1.00)和0.85(0.59~0.92),0.93(0.88~0.99)、0.84(0.78~0.97)和0.91(0.69~1.00),381.23(95%CI 98.04~1482.48)、113.20(95%CI 36.39~352.19)和73.59(95%CI 35.70~151.69),0.9671、0.9638和0.9575。结论 MPI/CTCA较单独MPI或单独CTCA无绝对优势,但鉴别冠状动脉痉挛所致MPI假阳性与代偿期冠状动脉狭窄所致MPI假阴性优势互补。     

microRNA和ctDNA诊断上皮性卵巢癌间接比较的Meta分析

目的采用Meta分析和基于共同参考标准的间接比较方法评价microRNA和ctDNA在上皮性卵巢癌(EOC)诊断中的临床价值。方法计算机检索PubMed、EMbase、Medline、The Cochrane Library、中国生物医学文献数据库(CBM)、中国期刊全文数据库(CNKI)、万方科技期刊全文数据库、维普中文科技期刊全文数据库(VIP),检索时限均从建库至2020年9月。由两名研究者根据事先制定的纳入及排除标准独立进行文献筛选并提取基本资料,依据诊断准确性研究的质量评估(QUADAS-2)工具评价文献质量。采用Meta-Disc 1.4软件和Stata 12.0软件进行Meta分析,计算合并敏感性、合并特异性、合并阳性似然比、合并阴性似然比、合并诊断优势比(DOR)。采用RevMan 5.3软件绘制汇总受试者工作特征曲线(SROC),采用敏感性分析评估结果的稳定性。采用Deek's漏斗图非对称检验评估是否存在发表偏倚。通过R软件实现microRNA和ctDNA间接比较的相对诊断比值比(RDOR)结果。结果最终纳入19篇文献,包含1351例EOC患者,1194例对照。异质性检验提示存在非阈值效应引起的明显异质性。采用随机效应模型对microRNA诊断EOC的研究进行Meta分析,结果显示,合并敏感性为0.74(95%CI:0.72~0.76),合并特异性为0.82(95%CI:0.80~0.84),合并阳性似然比为4.62(95%CI:3.35~6.38),合并阴性似然比为0.24(95%CI:0.17~0.35),合并DOR为21.62(95%CI:13.57~34.44),AUC为0.894。ctDNA诊断EOC的Meta分析结果显示,合并敏感性为0.76(95%CI:0.72~0.80),合并特异性为0.86(95%CI:0.83~0.89),合并阳性似然比为5.81(95%CI:3.60~9.38),合并阴性似然比为0.29(95%CI:0.21~0.41),合并DOR为22.61(95%CI:13.27~38.52),AUC为0.884。间接比较结果显示microRNA、ctDNA对EOC诊断的准确性之间差异无统计学意义。Deek's漏斗图非对称检验提示不存在明显发表偏倚。结论microRNA、ctDNA对EOC的临床诊断价值相当。     

超声造影对小肾肿瘤诊断价值的Meta分析

目的应用Meta分析系统评价超声造影对小肾肿瘤的诊断价值。方法计算机检索Cochrane图书馆、PubMed数据库、Embase、中国知网及万方数据库,搜索超声造影诊断小肾肿瘤的文献。检索时间为建库至2018年5月31日。由两位研究者严格按照纳入、排除标准进行文献筛选及数据提取,对纳入的文献采用QUADAS工具进行质量评价,应用Meta-Disc 1.4和Stata 12.0统计软件进行分析,计算超声造影鉴别诊断小肾肿瘤恶性病变的合并敏感性、特异性、阳性似然比、阴性似然比及诊断比值比;绘制汇总受试者工作特征曲线,获得曲线下面积和Q*指数。结果共纳入13篇文献(967个肿块),各文献间未见明显的发表偏倚,有较好的稳定性特征,未见明显异质性。超声造影鉴别诊断小肾肿瘤恶性病变的合并敏感性0.93(95%CI:0.91～0.94),合并特异性0.73(95%CI:0.66～0.79),合并阳性似然比3.30(95%CI:2.63～4.15),合并阴性似然比0.12(95%CI:0.09～0.15),合并诊断比值比31.91(95%CI:21.08～48.31),汇总受试者工作特征曲线下面积0.9309,Q*指数0.8661。结论超声造影对小肾肿瘤具有较高的诊断价值,值得临床推广应用。     

microRNA对子宫内膜癌诊断价值的Meta分析

目的利用Meta分析探讨微小核糖核酸(microRNA)在子宫内膜癌中的诊断价值。方法采用计算机检索PubMed、Cochrane Library、Embase、万方、知网、维普等数据库,收集有关microRNA诊断子宫内膜癌的文献。对文献进行筛选及质量评价、数据提取,使用诊断准确性研究的质量评价工具(QUADAS-2)评估文献质量。使用统计软件对灵敏度和特异度进行合并,分析诊断比值比(DOR)、阳性似然比(PLR)、阴性似然比(NLR),绘制综合受试者工作曲线(SROC)及计算曲线下面积(AUC),利用Deeks′漏斗图评估发表偏倚。结果该研究共纳入6篇文献,其中子宫内膜癌患者215例,对照者171例。合并后的灵敏度为0.78(95%CI:0.74~0.82),特异度为0.77(95%CI:0.71~0.82)。该研究中PLR和NLR分别为3.4(95%CI:2.7~4.2)和0.29(95%CI:0.24~0.34),DOR为12.0(95%CI:9.0~16.0),AUC为0.84(95%CI:0.81~0.87)。Deeks′漏斗图是对称的,说明不存在发表偏倚。结论microRNA是一种有潜力的诊断子宫内膜癌的生物标志物,具有较高的诊断准确性。     

血液循环游离DNA联合甲胎蛋白对肝细胞癌诊断价值的荟萃分析

目的通过荟萃(meta)分析评价循环游离DNA结合甲胎蛋白对于肝细胞癌的诊断价值。方法通过检索pubmed、web of science、Cochrane library、中国知网、中国生物医学文献数据库、维普数据库等多个数据库,检索建库至2018年5月间使用循环游离DNA结合甲胎蛋白作为诊断肝癌的文献,采用Stata 14.0软件进行分析。结果文章纳入10篇文献,包括838例HCC患者、702例非HCC患者;循环游离DNA结合AFP检测肝细胞癌的合并敏感性、特异性分别为0.80(95%CI:0.70~0.87)和0.95(95%CI:0.90~0.98),阳性似然比和阴性似然比分别为15.9(95%CI:7.6~36.6)和0.21(95%CI:0.13~0.32),诊断比值比为76(95%CI:28~228);ROC曲线下面积(AUCROC)为0.95(95%CI:0.93~0.97)。结论循环游离DNA联合甲胎蛋白对诊断肝癌具有更高的准确性,可以作为早期肝癌筛查的指标,并且定量分析比定性分析诊断准确性更高。     

Diagnostic accuracy of ultrasound for upper extremity fractures in children: A systematic review and meta-analysis

ObjectiveUltrasound has an excellent diagnostic accuracy for fractures that is reportedly comparable to plain radiographs. We aim to summarize the diagnostic accuracy of ultrasound for upper extremity fractures in children.MethodsDatabases were searched from inception through November 2019 using pre-defined index terms, including “ultrasound,” “fractures of upper extremities” and “children”. The study is reported using Preferred Reporting Items for a Systematic Review and Meta-analysis of Diagnostic Test Accuracy Studies (PRISMA-DTA). Meta-analysis of the diagnostic accuracy of ultrasound for fractures was conducted using the random-effects bivariate model. Subgroup analysis of fracture site (elbow vs non-elbow fractures) was also performed. Meta-regression was performed to determine if the site of fracture affected the diagnostic accuracy.ResultsThirty-two studies were identified in the meta-analysis. Ultrasound for fractures of the upper extremities has a sensitivity: 0.95 (95% CI: 0.93–0.97), specificity: 0.95 (95% CI: 0.91–0.98), positive likelihood ratio: 21.1 (95% CI: 10.8–41.5) and negative likelihood ratio: 0.05 (95% CI: 0.03–0.07), with an area under ROC (AUROC) curve of 0.98 (95% CI: 0.97–0.99). Subgroup analysis for elbow fracture showed ultrasound has a sensitivity: 0.95 (95% CI: 0.86–0.98), specificity: 0.87 (95% CI: 0.76–0.94), positive likelihood ratio: 7.3 (95% CI: 3.7–14.4) and negative likelihood ratio: 0.06 (95% CI: 0.02–0.16), with an AUROC of 0.96 (95% CI: 0.94–0.97). Meta-regression suggested the fracture sites would affect diagnostic accuracy of ultrasound (elbow vs non-elbow, p < 0.01).ConclusionsCurrent evidence suggests ultrasound has excellent diagnostic accuracy for non-elbow upper extremity fractures in children, serving as an alternative diagnostic modality to plain radiographs.     

Value of Assessment of Different Neoplasias in the Adnexa in the Differential Diagnosis of Malignant Ovarian Tumor and Benign Ovarian Tumor: A Meta-analysis

To evaluate the accuracy of the assessment of different neoplasias in the adnexa (ADNEX) model in the differential diagnosis of malignant and benign ovarian tumors, the optimal cutoff value and the accuracy in diagnosing ovarian tumors at different stages, PubMed, Web of Science and Cochrane Library databases were retrieved to search literature with per-patient analysis until publication of the last study in November 2021. STATA 14.1, Meta-Disc 1.4 and Revman software 5.3 were used in the performance of meta-analysis. To explore sources of heterogeneity, a subgroup analysis was conducted for the ADNEX model. The pooled sensitivity, specificity, diagnostic odds ratio, positive likelihood, negative likelihood ratio and area under the summary receiver operating characteristic curve were 0.91 (95% confidence interval [CI]: 0.89–0.93), 0.84 (95% CI: 0.80–0.88), 55.55 (95% CI: 40.47–76.26), 5.71 (95% CI: 4.49–7.26), 0.10 (95% CI: 0.08–0.13) and 0.94 (95% CI: 0.92–0.96) in differentiating benign and malignant ovarian tumors, respectively. The area under the curve in identifying benign, borderline, stage I and stages II–IV were 0.93, 0.73, 0.27 and 0.92. The ADNEX model had high diagnostic performance was influential in the diagnosis of benign and stage II–IV ovarian tumors.     

Diagnostic test accuracy of imaging modalities for adults with acute pulmonary embolism: A systematic review and meta-analysis

ObjectivesThis systematic review and meta-analysis aimed to evaluate the current literature on diagnostic test accuracy (DTA) of imaging modalities for adults with acute pulmonary embolism (APE).BackgroundMedical imaging plays an integral role in evaluating and managing those with APE. Guidance for imaging modality use for APE diagnosis varies due to a lack of clinical standardisation. Despite this, CTPA remains the first-line imaging modality used by clinicians.MethodsA literature search of PubMed, EMBASE, Trove and Mednar databases (2012-2020; English language) was performed. Studies assessing the DTA of imaging modalities for APE diagnosis were included. DTA studies methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2 tool). Results of eligible studies were pooled using random or fixed effects modelling the calculate the pooled DTA of explored imaging modalities for APE. The Higgins I² test were performed to assess between study heterogeneity.Results10 Studies, involving 998 participants, were enrolled and pooled using the random effects model. Of the explored modalities, magnetic resonance imaging (MRI), specifically pulmonary MRI and magnetic resonance pulmonary angiography (MRPA) exhibited the highest pooled DTA. Sensitivity, specificity, negative likelihood ratio, positive likelihood ratio and diagnostic odds ratio for MRPA were 0.952 (95% CI, 0.881 to 0.987), 0.857 (95% CI, 0.637 to 0.97), 5.631 (95% CI, 2.163 to 14.659), 0.06 (95% CI, 0.007 to 0.537) and 80.310 (95% CI, 15.607 to 413.25) respectively. Based on the QUADAS-2 criteria, most studies presented low to moderate risk of bias and concern regarding applicability.ConclusionThe explored ultrasound and MRI protocols which exhibit a lower radiation burden when compared to the current gold standard computed tomography pulmonary angiography (CTPA), have acceptable diagnostic accuracy for APE and can be useful in certain situations.     

Diagnostic value of serum squamous cell carcinoma antigen for hepatocellular carcinoma: a systematic review and meta-analysis

The aim of this study was to ascertain the diagnostic value of serum squamous cell carcinoma antigen (SCCA) and SCCA-IgM for hepatocellular carcinoma (HCC). After a comprehensive search of PubMed and Web of Science databases, we identified eligible studies on the diagnostic value serum SCCAs for HCC. The quality of the eligible studies was assessed using the revised Quality Assessment for Studies of Diagnostic Accuracy (QUADAS-2) tool. The overall diagnostic value of SCCAs for HCC was pooled using a bivariate model. Twelve studies were included in this systematic review and meta-analysis. The pooled sensitivities for SCCA and SCCA-IgM were 0.61 (95% confidence interval [CI], 0.37–0.81) and 0.70 (95% CI, 0.55–0.82), respectively. The corresponding specificities were 0.80 (95% CI, 0.52–0.94) and 0.62 (95% CI, 0.51–0.72), respectively. The areas under summary receiver operating characteristic (sROC) curves for SCCA and SCCA-IgM were 0.76 (95% CI, 0.72–0.80) and 0.70 (95% CI, 0.66–0.74), respectively. Major design deficiencies of the included studies were two-gate design and partial verification bias. Therefore, we concluded that both serum SCCA and SCCA-IgM have a fair diagnostic value for HCC.     

Quantitative Shear Wave Velocity Measurement on Acoustic Radiation Force Impulse Elastography for Differential Diagnosis between Benign and Malignant Thyroid Nodules: A Meta-analysis

The aim of this study was to evaluate the diagnostic performance of quantitative shear wave velocity (SWV) measurement on acoustic radiation force impulse (ARFI) elastography for differentiation between benign and malignant thyroid nodules using meta-analysis. The databases of PubMed and the Web of Science were searched. Studies published in English on assessment of the sensitivity and specificity of ARFI elastography for the differentiation of thyroid nodules were collected. The quantitative measurement of ARFI elastography was evaluated by SWV (m/s). Meta-Disc Version 1.4 software was used to describe and calculate the sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio and summary receiver operating characteristic curves. We analyzed a total of 13 studies, which included 1,854 thyroid nodules (including 1,339 benign nodules and 515 malignant nodules) from 1,641 patients. The summary sensitivity and specificity for differential diagnosis between benign and malignant thyroid nodules by SWV were 0.81 (95% confidence interval [CI]: 0.77–0.84) and 0.84 (95% CI: 0.81–0.86), respectively. The pooled positive and negative likelihood ratios were 5.21 (95% CI: 3.56–7.62) and 0.23 (95% CI: 0.17–0.32), respectively. The pooled diagnostic odds ratio was 27.53 (95% CI: 14.58–52.01), and the area under the summary receiver operating characteristic curve was 0.91 (Q* = 0.84). In conclusion, SWV measurement on ARFI elastography has high sensitivity and specificity for differential diagnosis between benign and malignant thyroid nodules and can be used in combination with conventional ultrasound.     

Meta-Analysis: Contrast-Enhanced Ultrasound Versus Conventional Ultrasound for Differentiation of Benign and Malignant Breast Lesions

This meta-analysis aimed to compare the diagnostic performance of contrast-enhanced ultrasound (CEUS), conventional ultrasound (US) combined with CEUS (US?+?CEUS) and US for distinguishing breast lesions. From thorough literature research, studies that compared the diagnostic performance of CEUS versus US or US?+?CEUS versus US, using pathology results as the gold standard, were included. A total of 10 studies were included, of which 9 compared the diagnostic performance of CEUS and US, and 5 studies compared US?+?CEUS and US. In those comparing CEUS versus US, the pooled sensitivity was 0.93 (95% CI: 0.91–0.95) versus 0.87 (95% CI: 0.85–0.90) and pooled specificity was 0.86 (95% CI: 0.84–0.88) versus 0.72 (95% CI: 0.69–0.75). In studies comparing US?+?CEUS versus US, the pooled sensitivity was 0.94 (95% CI: 0.92–0.96) versus 0.87 (95% CI: 0.84–0.90) and pooled specificity was 0.86 (95% CI: 0.82–0.89) versus 0.80 (95% CI: 0.76–0.84). In terms of diagnosing breast malignancy, areas under the curve of the summary receiver operating characteristic (of both CEUS (p?=?0.003) and US?+?CEUS (p?=?0.000) were statistically higher than that of US. Both CEUS alone and US?+?CEUS had better diagnostic performance than US in differentiation of breast lesions, and US?+?CEUS also had low negative likelihood ratio.     

Lung Ultrasound,a Better Choice for Neonatal Pneumothorax: A Systematic Review and Meta-analysis

Neonatal pneumothorax is a life-threatening condition. Chest X-ray is the main diagnostic method but has some defects. Lung ultrasound has emerged as a diagnostic method in recent years. The aim of this review was to compare the diagnostic accuracy of lung ultrasound against chest X-ray in neonates with pneumothorax. We searched the Chinese journal full-text database, Wanfang database, China biomedical document service system, Weipu Chinese science and technology periodical full-text database, EMBASE, PubMed, The Cochrane Library and Web of Science (up to January 2020) for prospective studies on the diagnostic accuracy of lung ultrasound in neonates with pneumothorax. Statistical analysis was undertaken using Meta-DiSc software, version 1.4 (Romany Cajal Hospital, Madrid, Spain). The search returned 528 studies, of which 8 full texts were assessed for eligibility against the inclusion/exclusion criteria. The overall specificity and sensitivity of lung ultrasound in the diagnosis of neonatal pneumothorax was 98% (95% confidence interval [CI]: 0.94–0.99) and 99% (95% CI: 0.98–1.00), respectively. The diagnostic odds ratio was 920.01 (95% CI: 265.81–3184.33), and the area under the curve was 0.996 7 (Q* = 0.978 5). However, the chest X-ray was always taken as the reference standard with a sensitivity of 82% (95% CI: 0.72–0.90), a specificity of 96% (95% CI: 0.90–0.99) and a diagnostic odds ratio of 44.54 (95% CI: 4.30–460.98). Study analysis studies indicated that the sensitivity of lung ultrasound in diagnosing pneumothorax excepted chest X-ray as the single diagnosis criteria was 98% (95% CI: 0.93–1.00), the specificity was 100% (95% CI: 0.96–1.00) and the diagnostic odds ratio was 965.39 (95% CI: 161.195781.93), showing a higher accuracy than chest X-ray. In conclusion, lung ultrasound had better sensitivity and specificity than chest X-ray in the diagnosis of pneumothorax. Some ultrasonic signs (absence of lung sliding or B-lines) had a high sensitivity in the diagnosis, which could be used to diagnose pneumothorax. Lung point could help judge the severity of pneumothorax. Its presence indicates that pneumothorax is mild to moderate; otherwise, pneumothorax is severe.     

mTI-ASL技术在鉴别脑胶质瘤术后复发与放射性损伤中的应用价值

目的应用多反转时间动脉自旋标记(multiple inversion time-pulsed arterial spin labeling,mTI-ASL)技术,定量分析脑胶质瘤术后复发与放射性损伤的不同,进一步评估该技术对两者的鉴别诊断价值。材料与方法使用西门子公司3.0 T Skyra扫描仪,收集2017年1月到2018年12月在内蒙古医科大学附属医院就诊的脑胶质瘤术后放疗后MR增强扫描出现异常强化灶的患者,并经手术后病理及临床随访证实脑胶质瘤二次复发20例,放射性损伤10例,行mTI-ASL序列扫描。mTI-ASL原始图像通过MATLAB软件进行后处理,得到脑血流量(cerebral blood flow,CBF)图和动脉通过时间(arterial transit time,ATT)图,应用MRIcron软件手动勾画感兴趣区,测量术后异常强化区的定量CBF值和ATT值。分别采用独立样本t检验比较脑胶质瘤术后复发与放射性损伤感兴趣区相关参数值,评价定量参数CBF值和ATT值的差异,从而评估mTI-ASL技术对二者的鉴别诊断能力。结果(1)对比脑胶质瘤术后复发与放射性损伤CBF值,脑胶质瘤术后复发CBF值(6.38±1.41),比放射性损伤CBF值(2.30±0.37)高,两者比较具有统计学意义(P<0.01);(2)对比脑胶质瘤术后复发与放射性损伤ATT值,脑胶质瘤术后复发ATT值(0.19±0.30),比放射性损伤CBF值(0.16±0.12)高,两者比较具有统计学意义(P<0.01)。结论mTI-ASL技术中定量CBF及ATT值可以对高级别脑胶质瘤术后复发与放射性损伤进行鉴别。