Diagnostic accuracy of transesophageal echocardiography, helical computed tomography, and magnetic resonance imaging for suspected thoracic aortic dissection - Systematic review and meta-analysis

被引:274
作者
Shiga, Toshiya
Wajima, Zen'ichiro
Apfel, Christian C.
Inoue, Tetsuo
Ohe, Yoko
机构
[1] Univ Ohashi, Med Ctr, Dept Anesthesiol, Meguro Ku, Tokyo 1538515, Japan
[2] Chiba Hokusoh Hosp, Nippon Med Sch, Dept Anesthesia, Chiba, Japan
[3] Univ Calif San Francisco, Dept Anesthesia & Preoperat Care, San Francisco, CA 94143 USA
关键词
D O I
10.1001/archinte.166.13.1350
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: Patients with suspected thoracic aortic dissection require early and accurate diagnosis. Aortography has been replaced by less invasive imaging techniques including transesophageal echocardiography (TEE), helical computed tomography (CT), and magnetic resonance imaging (MRI); however, accuracies have varied from trial to trial, and which imaging technique should be applied to which risk population remains unclear. We systematically reviewed the diagnostic accuracy of these imaging techniques in patients with suspected thoracic aortic dissection. Methods: Published English- language reports on the diagnosis of thoracic aortic dissection by TEE, helical CT, or MRI were identified from electronic databases. Sensitivity, specificity, and positive and negative likelihood ratios were pooled in a random-effects model. Results: Sixteen studies involving a total of 1139 patients were selected. Pooled sensitivity (98%-100%) and specificity (95%-98%) were comparable between imaging techniques. The pooled positive likelihood ratio appeared to be higher for MRI (positive likelihood ratio, 25.3; 95% confidence interval, 11.1-57.1) than for TEE (14.1; 6.0-33.2) or helical CT (13.9; 4.2-46.0). If a patient had shown a 50% pretest probability of thoracic aortic dissection (high risk), he or she had a 93% to 96% posttest probability of thoracic aortic dissection following a positive result of each imaging test. If a patient had a 5% pretest probability of thoracic aortic dissection (low risk), he or she had a 0.1% to 0.3% posttest probability of thoracic aortic dissection following a negative result of each imaging test. Conclusion: All 3 imaging techniques, ie, TEE, helical CT, and MRI, yield clinically equally reliable diagnostic values for confirming or ruling out thoracic aortic dissection.
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页码:1350 / 1356
页数:7
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