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

To compare the diagnostic value of transvaginal ultrasound (TVS) and magnetic resonance imaging (MRI) in cesarean scar pregnancy (CSP) by a method of meta-analysis. Studies on TVS and MRI for CSP were collected from PubMed, Cochrane Library, Embase, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang data, and Chinese Scientific Journal Database (VIP database) until April 1, 2024. Stata 15.0 software was used for data analysis. Mann–Whitney U-test was applied to compare the diagnostic efficiency of the TVS and MRI groups. Nine articles with 713 subjects were involved in this review. The pooled sensitivity (0.96, 95%CI: 0.94–0.97), specificity (0.90, 95%CI: 0.84–0.94), and DOR (197.28, 95%CI: 99.71–390.31) in the MRI group were higher than those (Sensitivity = 0.83, 95%CI: 0.77–0.87; Specificity= 0.74, 95%CI: 0.63–0.83; DOR = 13.66, 95%CI: 7.84–23.79) in the TVS group. The positive likelihood ratio and negative likelihood ratio of the MRI group were 9.56 (95%CI: 8.82–15.72) and 0.05 (95%CI: 0.03–0.07), while those of the TVS group were 3.21 (95%CI:2.18–4.74) and 0.24 (95%CI: 0.18–0.31), respectively. In the MRI and TVS groups, the area under the curve (AUC) of the summary receiver operating characteristic was 0.9497 and 0.86, respectively. The results of Mann–Whitney U-tests of the two groups showed significant differences in the pooled sensitivity (Z= −3.311, p p = 0.034), and DOR (Z= −3.272, p = 0.001). Both MRI and TVS can effectively diagnose CSP. However, compared with TVS, MRI has better diagnostic accuracy for CSP, with higher sensitivity and specificity. Considering the good diagnostic accuracy of ultrasound, patients with ultrasound suspicion of CSP should be sent to a reference center where MRI can express its full diagnostic potential regarding depth, topography of invasion and myometral residue, which is useful for subsequent management.

本研究旨在通过荟萃分析方法，比较经阴道超声（transvaginal ultrasound，TVS）与磁共振成像（magnetic resonance imaging，MRI）在剖宫产瘢痕妊娠（cesarean scar pregnancy，CSP）中的诊断价值。研究检索了截至2024年4月1日，PubMed、Cochrane图书馆、Embase、Web of Science、中国知网（China National Knowledge Infrastructure，CNKI）、万方数据及中文科技期刊数据库（维普数据库，Chinese Scientific Journal Database，VIP数据库）中关于TVS与MRI诊断CSP的相关文献。采用Stata 15.0统计软件进行数据分析，运用曼-惠特尼U检验比较TVS组与MRI组的诊断效能。本综述共纳入9篇文献，涉及713名研究对象。MRI组的合并敏感度（0.96，95%置信区间：0.94~0.97）、合并特异度（0.90，95%置信区间：0.84~0.94）及合并诊断比值比（diagnostic odds ratio，DOR）（197.28，95%置信区间：99.71~390.31）均高于TVS组[敏感度：0.83，95%置信区间：0.77~0.87；特异度：0.74，95%置信区间：0.63~0.83；DOR：13.66，95%置信区间：7.84~23.79]。MRI组的阳性似然比与阴性似然比分别为9.56（95%置信区间：8.82~15.72）与0.05（95%置信区间：0.03~0.07），TVS组则分别为3.21（95%置信区间：2.18~4.74）与0.24（95%置信区间：0.18~0.31）。MRI组与TVS组的综合受试者工作特征曲线下面积（area under the curve，AUC）分别为0.9497与0.86。两组曼-惠特尼U检验结果显示，合并敏感度（Z=-3.311，P=0.001）、合并特异度（Z=-2.121，P=0.034）及DOR（Z=-3.272，P=0.001）组间差异均具有统计学意义。研究结果表明，MRI与TVS均可有效诊断CSP，但相较于TVS，MRI对CSP的诊断准确度更优，其敏感度与特异度均更高。鉴于超声诊断准确度良好，对于超声疑似CSP的患者，应将其转诊至可开展MRI检查的参考中心，以充分发挥MRI在评估浸润深度、侵袭范围及子宫肌层残余方面的诊断潜力，可为后续临床诊疗提供重要依据。