Computed tomography for the diagnosis of varices in liver cirrhosis: a systematic review and meta-analysis of observational studies

<b>Objectives:</b> This systematic review and meta-analysis aimed to evaluate the diagnostic accuracy of contrast-enhanced computed tomography (CT) for varices in liver cirrhosis. <b>Methods</b>: PubMed and EMBASE databases were searched for the literature identification. The area under the summary receiver operating characteristic curve (AUSROC), sensitivity, specificity, positive and negative likelihood ratio (PLR and NLR), and diagnostic odds ratio (DOR) were calculated. We performed the subgroup analyses according to the location of varices, CT technique, and study design. The study quality was assessed according to the QUADAS-2 tool. <b>Results:</b> Seventeen papers were eligible. The study quality was modest. The AUSROC was 0.8975 and 0.9494 for predicting any size and high-risk varices, respectively. Summary sensitivity, specificity, PLR, NLR, and DOR of CT for predicting any size and high-risk varices were 0.87/0.80/3.67/0.18/22.70 and 0.87/0.88/7.52/0.12/65.55, respectively. According to the location of varices, the AUSROC was 0.9127 for predicting any size gastric varices alone; and the AUSROC was 0.8958 and 0.9461 for predicting any size and high-risk esophageal varices alone, respectively. According to the CT technique, the AUSROC of multi-detector CT (MDCT) was 0.9047 and 0.9490 for predicting any size and high-risk varices, respectively; and the AUSROC of MDCT esophagograms for predicting any size and high-risk varices was 0.8735 and 0.9664, respectively. In the subgroup analysis of prospective studies, the AUSROC was 0.9122 and 0.9507 for predicting any size and high-risk varices, respectively. <b>Conclusion:</b> CT had a high accuracy for the diagnosis of varices in liver cirrhosis.

<b>研究目的：</b> 本系统评价与荟萃分析旨在评估增强计算机断层扫描（computed tomography，CT）对肝硬化患者静脉曲张的诊断效能。<b>研究方法：</b> 通过检索PubMed与EMBASE数据库以识别相关文献，计算综合受试者工作特征曲线下面积（area under the summary receiver operating characteristic curve，AUSROC）、灵敏度、特异度、阳性似然比与阴性似然比（positive and negative likelihood ratio，PLR与NLR）以及诊断比值比（diagnostic odds ratio，DOR）。本研究依据静脉曲张部位、CT检查技术以及研究设计类型进行亚组分析，并采用QUADAS-2量表对研究质量进行评估。<b>研究结果：</b> 最终纳入17篇符合标准的文献，研究整体质量中等。在预测任意大小静脉曲张与高危静脉曲张时，综合受试者工作特征曲线下面积分别为0.8975与0.9494。CT预测任意大小静脉曲张与高危静脉曲张的综合灵敏度、特异度、阳性似然比、阴性似然比及诊断比值比分别为0.87/0.80/3.67/0.18/22.70与0.87/0.88/7.52/0.12/65.55。按静脉曲张部位分层分析时，单独预测任意大小胃静脉曲张的综合受试者工作特征曲线下面积为0.9127；单独预测任意大小食管静脉曲张与高危食管静脉曲张的该面积分别为0.8958与0.9461。按CT检查技术分层分析时，多排螺旋CT（multi-detector CT，MDCT）预测任意大小静脉曲张与高危静脉曲张的综合受试者工作特征曲线下面积分别为0.9047与0.9490；而MDCT食管造影预测任意大小与高危静脉曲张的该面积分别为0.8735与0.9664。在前瞻性研究亚组分析中，CT预测任意大小静脉曲张与高危静脉曲张的综合受试者工作特征曲线下面积分别为0.9122与0.9507。<b>研究结论：</b> 增强CT对肝硬化患者静脉曲张具有较高的诊断效能。