Value Of Contrast-enhanced Ultrasound In Differential Diagnosis Of Benign And Malignant Portal Vein Emboli: A Meta-analysis

Background:The benign and malignant emboli of portal vein are commonly derived from patients with cirrhosis and liver cancer.With the increasing number of patients with liver cancer,there are more and more patients with benign and malignant portal vein emboli.In addition,portal vein thrombosis can also be caused by blood hypercoagulability,abdominalinfectionand myeloproliferative diseases.At present,ultrasound,CT and MRI are commonly used in the differential diagnosis of benign and malignant portal vein emboli.Ultrasound is the preferred method for the differential diagnosis of benign and malignant portal vein emboli.Pathological diagnosis is the gold standard for the differential diagnosis of benign and malignant portal vein emboli,but it is invasive examination,and puncture biopsy is difficult,so it is not used as routine.In recent years,CEUS has been widely used in the diagnosis of various clinical diseases,greatly improving the diagnosis accuracy of benign and malignant emboli of portal vein,which has high clinical application value.Purpose:By using the method of meta-analysis,all the published data of the differential diagnosis value of CEUS in the differential diagnosis of benign and malignant portal vein emboli were summarized and statistically analyzed,so as to objectively and accurately evaluate it and provide evidence-based medical evidence for clinical practice.Methods:We searched Pub Med,EMBASE,the Cochrane Library,CNKI and Wanfang databases for all relevant literatures published from the establishment of the database to may 2020,and conducted a manual secondary search.According to the inclusion and exclusion criteria formulated in advance,the included literatures were strictly selected,and the four grid table data(true positive value,false positive value,false negative value,true negative value)and main information(author,year of publication,country,gender ratio,number of lesions,mean age,study type,contrast agent,etc.)of all included literatures were extracted.QUADAS-2 was used to evaluate the quality of all included literatures.According to the heterogeneity test results,the corresponding effect models were selected for meta-analysis,and the combined sensitivity,combined specificity,combined positive likelihood ratio,combined negative likelihood ratio,combined diagnostic odds ratio were calculated,and the summary receiver operator characteristic curve was drawn and the area under curve was calculated.If there is heterogeneity among the included articles,it is necessary to detect whether there is threshold effect,and subgroup analysis is needed to find the source of heterogeneity.Conduct sensitivity analysis to test whether this study is stable and reliable.Draw the funnel plot of deek’s to test whether there is publication bias.Results:A total of 14 articles were included in this meta-analysis.Published from 2000 to 2019.There were 682 emboli,including425 malignant emboli and 257 benign emboli,with a positive rate of 62%.Using the bivariate model,the I~2 value of sensitivity was 47.1%,P value was 0.026,and the I~2 value of specificity was 13.8%,P value was 0.302,indicating that there was moderate heterogeneity in this meta-analysis.Spearman correlation coefficient was 0.361,and P value was 0.205,indicating that there was no threshold effect in this study.Subgroup analysis showed that the differences of study type and race may be the source of heterogeneity.The pooled sensitivity was 0.95(95%CI:0.93-0.97),I~2=47.1%,P=0.026.The pooled specificity was 0.99(95%CI:0.97-1.00),I~2=13.8%,P=0.302.The pooled positive likelihood ratio was 16.52(95%CI:8.50-32.11),I~2=13.2%,P=0.309.The pooled negative likelihood ratio was0.08(95%CI:0.06-0.12),I~2=0.0%,P=0.712.The pooled DOR value was 363.42(95%CI:157.63-837.89),I~2=0.0%,P=0.928.The area under the SROC curve was 0.986.Sensitivity analysis results showed that the results of this study are stable and reliable.The results of publication bias test showed no significant publication bias.Conclusion:CEUS has high value and advantages in differential diagnosis of benign and malignant portal vein emboli,and is recommended to be widely used in clinical diagnosis.