meta分析课件.pptx

Accuracy of MRI, MR Arthrography, and Ultrasound in the Diagnosis of Rotator Cuff Tears: A Meta-Analysis,MRI、MR关节造影、超声诊断肩袖撕裂的准确性：Meta分析,,OBJECTIVE. The purpose of this study was to compare the diagnostic accuracy of MRI,MR arthrography, and ultrasound for the diagnosis of rotator cuff tears through a meta-analysis of the studies in the literature.,目的：通过学习文献进行一个meta分析，来比较MRI、MR关节造影和超声在诊断肩袖撕裂的准确性MATERIALS AND METHODS.Articles reporting the sensitivities and specificities of MRI, MR arthrography, or ultrasound for the diagnosis of rotator cuff tears were identified. Surgical(open and arthroscopic) reference standard was an inclusion criterion. Summary statistics were generated using pooled data. Scatterplots of the data sets were plotted on a graph of sensitivity versus (1 – specificity). Receiver operating characteristic (ROC) curves were generated.,材料与方法：文献报道，MRI、MR关节造影和超声在诊断肩袖撕裂的敏感性和特异性是确定的。

外科手术（切开和关节镜）的证明标准是一种收入标准，通过对汇总数据的总结形成统计数字、数据设置的散点绘图，在一张敏感性对（1-特异性）的图上进行标绘，就形成Receiver operating characteristic（ROC）曲线RESULTS. Sixty-five articles met the inclusion criteria for this meta-analysis. In diagnosing a full-thickness tear or a partial-thickness rotator cuff tear, MR arthrography is more sensitive and specific than either MRI or ultrasound (p 0.05).,结果：65篇文章符合这个meta分析的收入标准在诊断一个完全或部分的肩袖撕裂时，MR关节造影比MRI或超声更敏感和专业（p0.05）Summary ROC curves for MR arthrography,MRI, and ultrasound for all tears show the area under the ROC curve is greatest for MR arthrography (0.935), followed by ultrasound (0.889) and then MRI (0.878); however,pairwise comparisons of these curves show no significant differences between MRI and ultrasound(p > 0.05).,MR关节造影、MRI、超声在概括ROC曲线上，对所有撕裂，MR关节造影的ROC曲线最棒（0.935），超声次之（0.889），MRI（0，878），但是，成对比较这些曲线，MRI和超声没有显著区别（p>0.05）。

CONCLUSION. MR arthrography is the most sensitive and specific technique for diagnosing both full- and partial-thickness rotator cuff tears. Ultrasound and MRI are comparable in both sensitivity and specificity.,结论：在诊断完全和部分撕裂时，MR关节造影是最敏感和最特异的，超声和MRI在敏感和特异方面差不多In the workup of patients with shoulder pain, the role of imaging is to guide treatment decisions [1,2]. The diagnosis of a rotator cuff tear and its extent, full or partial thickness, can determine whether the patient will be managed conservatively or will need surgery [3, 4].Furthermore,the surgical approach, open versus arthroscopic, can be chosen once the correct diagnosis is made [3, 5].,在研究肩关节疼痛的病人时，成像技术扮演的角色是指导治疗措施（1，2），诊断肩袖撕裂的程度，包括完整或部分厚度来决定患者是否将保守治疗或进行外科手术（3，4），而且，一旦有了正确的诊断，就可以选择外科手术的方法，切开或关节镜（3，5）。

Of the various imaging tests that have been used to evaluate the painful shoulder, unenhanced MRI, indirect and direct MR arthrography, and ultrasound have become the standards by which a rotator cuff tear is diagnosed.,多种成像检测已经经常用于衡量疼痛的肩关节：非增强MRI、间接或直接MR关节造影、超声，在诊断肩袖撕裂时已成为标准Materials and Methods A comprehensive literature search of the MEDLINE database was performed using the following keywords: rotator cuff and rotator cuff tear; magnetic resonance imaging, magnetic resonance, MRI, and MR; magnetic resonance arthrography and MR arthrography; ultrasound,ultrasonography, sonography, and US.,材料和方法 在操作一个广泛的MEDLINE数据库信息资源和文献搜索时我们用了以下几个关键词：肩袖和肩袖撕裂，核磁共振成像，核磁共振，MRI和MR，核磁关节造影和MR关节造影，超声，超声成像，超声学和US。

Articles published from 1966 to September 2007 were searched and included publications in all languages and involving human and animal subjects.,已发表的文献从1966年到2007年9月，包括所有语言和人类及动物课题Study Selection Our query of the MEDLINE database returned 1,195 hits. The articles were analyzed for concordance with the inclusion criteria. These criteria are English language; absolute (raw) data on rotator cuff tears (full or partial thickness or both) in the form of true-positives(TPs), truenegatives(TNs), false-positives (FPs), and falsenegatives(FNs) either provided or extractable;surgical reference standard (arthroscopy or open surgery); and diagnostic imaging studies interpreted by radiologists.,研究选择 在MEDLINE数据库，我们检索到1，195个目标。

为了得到一致性包含标准，我们对文章进行了分析这些标准为英语；关于肩袖撕裂绝对的（新录）数据（完整或部分撕裂或两者兼有）；以任何一个提供的或提取的正阳性（TPs）、正阴性（TNs）、假阳性（FPs）和假阴性（FNs）为形式；外科收入标准（关节镜或切开手术）；研究由放射学学者解释诊断成像结果In addition, data must not have been published in a prior study. To prevent this possibility, we included only the article with the earlier publication date if two articles with common authors or from the same institution had overlapping dates of subject inclusion.,另外，在先前的研究中，数据不能已发表为了避免这种可能性，如果两篇文章有相同作者或结论有重叠且来自同一研究机构，我们仅选录发表时间较早的文章Non-English-language (n = 160) and animal (n =1) studies were excluded. The abstracts of the remaining studies were evaluated for relevance to our study. Of these, 270 relevant articles were retrieved. One hundred sixty-two of the 270 were excluded because either raw data were not provided or the data could not be extracted into discrete TPs, TNs, FPs, and FNs.,没有英语的文章（n=160）和动物课题（n=1）等研究被排除，剩余已评估的研究摘要与我们研究相关。

在这些文章里，270篇文章被检查，270篇里162篇被排除，因为要么没有提供最新的技术，要么数据不能被提取成的TPs、TNs、FPs和FNsOf the remaining 108 articles with data, 43 were excluded for the following reasons: 18 studies had a nonsurgical standard of reference, 15 had ultrasound read by nonradiologists, one had MRI read by nonradiologists,and nine had overlapping dates of subject inclusion with other studies by common authors from the same institution.,。