影像学检查在单发肺肿块诊断中的meta分析

目的评价几种影像学检查方法对单发肺肿块恶性病变的诊断价值。同时创建一个根据各种诊断方法的临床数据建立的线图及图表来帮助诊断恶性病变。方法对CT、PET、MR及SPECT在诊断恶性肿块中的作用做回顾性分析。每一种诊断方法对单发性肺肿块恶性病变鉴别的阳性及阴性似然比均被再次仔细计算。各种诊断方法的阳性似然比分别为CT3.91（95%可信区间2.42,5.40）,MRI4.57（3.03,6.1）,PET5.44（3.56,7.32）及SPECT5.16（4.03,6.30）。阴性似然比为：CT0.10（0.03,0.16）,MRI0.08（0.03,0.12）,PET0.06（0.02,0.09）、SPECT0.06（0.04,0.08）。结论对于所有诊断方法来说它们之间诊断价值的差异是非常小的。SPECT似乎应该成为单发肺肿块诊断的首选方法。

Solitary Pulmonary Nodules and Masses: a Meta-analysis of the Diagnostic Utility of Alternative Imaging Tests

The aim of this article was to assess the clinical effects of diagnostic tests for evaluating malignancy within a solitary pulmonary nodule （SPN）, and to establish a nomogram or table using clinical data and noninvasive radiology （positive） test results to estimate post-test probability of malignancy. Studies that examined computed tomography （CT）, magnetic resonance imaging （MRI）, positron emission tomography （PET） and single photon emission computed tomography （SPECT） for the evaluation of SPN. Study-specific and overall positive likelihood ratios （LRs） for each diagnostic test confirming a diagnosis of malignancy and negative LR for each diagnostic test excluding a diagnosis of malignancy within an SPN were calculated. Positive LRs for diagnostic tests were： CT 3.91 （95% confidence interval 2.42, 5.40）, MRI 4.57 （3.03, 6.1）, PET 5.44 （3.56, 7.32） and SPECT 5.16 （4.03, 6.30）. Negative LRs were： CT 0.10 （0.03, 0.16）, MRI 0.08 （0.03, 0.12）, PET 0.06 （0.02, 0.09） and SPECT 0.06 （0.04, 0.08）. Given the less cost and prevalence of the technology, SPECT seems to be the first choice for additional testing in SPN evaluation.