经阴道超声与MRI对剖宫产瘢痕部位妊娠诊断价值比较:Meta分析  

Comparison of the diagnostic value of transvaginal ultrasonography and MRI in cesarean scar pregnancy:a Meta-analysis

作　　者：王飞 鄢春月 程福 阳明[1] 聂悦[1] WANG Fei;YAN Chunyue;CHENG Fu;YANG Ming;NIE Yue(Department of Medical Imaging,Luzhou People’s Hospital,Luzhou,Sichuan Province 646000,China;Department of Obstetrics and Gynecology,the Affiliated Hospital of Southwest Medical University,Luzhou,Sichuan Province 646000,China;Department of Hematology,West China Hospital of Sichuan University,Chengdu 610041,China)

机构地区：[1]泸州市人民医院医学影像科,四川泸州646000 [2]西南医科大学附属医院妇产科,四川泸州646000 [3]四川大学华西医院输血科,四川成都610041

出　　处：《实用放射学杂志》2021年第7期1144-1148,共5页Journal of Practical Radiology

摘　　要：目的 比较经阴道超声(TVS)和MRI对剖宫产瘢痕部位妊娠(CSP)的诊断价值.方法 检索PubMed等数据库中TVS及MRI诊断CSP的研究,由2位研究者根据纳入与排除标准独立筛选文献、提取资料,并对纳入的研究进行质量评价.运用统计学软件进行分析汇总.结果 共纳入11篇文献,788例患者(MRI组628例,TVS组765例).MRI组和TVS组汇总敏感度分别为0.93和0.81,特异度分别为0.85和0.77,诊断比值比分别为64.64和16.45,曲线下面积(AUC)值分别为0.9497和0.8756,Q*值为0.8901和0.8060.采用Mann-Whitney U检验比较2组诊断效能.汇总敏感度(Z=-2.037,P=0.042)和诊断比值比(Z=-3.141,P=0.002)差异有统计学意义,汇总特异度(Z=-1.163,P=0.245)差异无统计学意义.2组对CSP孕囊是否崁入肌层向膀胱突起(Z=4.39,P<0.0001)、是否为囊性孕囊(Z=2.85,P=0.004)及合并孕囊或宫腔内出血(Z=6.49,P<0.00001)的诊断差异有统计学意义,对是否为包块型孕囊(Z=0.22,P=0.83)诊断差异无统计学意义.TVS组汇总敏感度有较高异质性,亚组分析显示所用设备厂家数可能为异质性来源,且组间(2个厂家vs 1个厂家)汇总敏感度差异有统计学意义(Z=-2.05,P=0.04).结论 相比于TVS,MRI对CSP的诊断准确性及敏感度更高,在CSP孕囊是否崁入肌层向膀胱突起、是否为囊性孕囊及合并孕囊或宫腔内出血等方面,其诊断价值更优.对于条件允许的CSP疑诊患者,妇产科医师可优先考虑MRI检查.Objective To compare the diagnostic value of transvaginal ultrasonography(TVS)and MRI in cesarean scar pregnancy(CSP).Methods The studies on the diagnosis of CSP by TVS and MRI were searched in PubMed and other databases.The two researchers independently screened the literatures,extracted data according to the inclusion and exclusion criteria,evaluated the quality of the included studies,and then the pooled results were analyzed by using the statistical software.Results All of the 788 patients(628 in the MRI group and 765 in the TVS group)were included in the 11 literatures.In the MRI group and the TVS group,the pooled sensitivity were 0.93 and 0.81,the specificity were 0.85 and 0.77,the diagnostic odds ratio were 64.64 and 16.45,the area under the curve(AUC)value were 0.9497 and 0.8756,and the Q* value were 0.8901 and 0.8060,respectively.The Mamn-Whitney U test was used to compare the diagnostic eficacy of the two groups,and the dfferences in the pooled sensitivity(Z=-2.037,P=0.042)and the diagnostic odds ratio(Z=-3.141,P=0.002)were statistically significant,while the difference in the pooled specificity(Z=-1.163,P=0.245)was not statistically significant.Between the two groups,there were significant differences in the diagnosis of the gestational sac penetrated into the muscular layer and protruded toward the bladder(Z=4.39,P<0.0001),cystic pregnancy sac(Z=2.85,P=0.004),and combined with gestational sac or intrauterine hemorrhage(Z=6.49,P<0.00001);there was no significant difference in the diagnosis of the mixed agglomerate(Z=0.22,P=0.83).The TVS group had higher heterogeneity in the sensitivity.Subgroup analysis showed that the number of equipment manufacturers might be a source of heterogeneity,and there was significant difference in the pooled sensitivity between the group with 2 manufacturers and the group with 1 manufacturer(Z=-2.05,P=0.04).Conclusion Compared with TVS,MRI is more accurate and sensitive in the diagnosis of CSP,especially in the diagnosis of the gestational sac penetrates into the muscular l

关 键 词：剖宫产瘢痕部位妊娠 磁共振成像 经阴道超声 META分析 

分 类 号：R714.2[医药卫生—妇产科学] R445.2[医药卫生—临床医学]