title: Diagnostic accuracy of computer tomography angiography and magnetic resonance angiography in the stenosis detection of autologuous hemodialysis access: a meta-analysis.
abstract: OBJECTIVE
  To compare the diagnostic performances of computer tomography angiography (CTA) and magnetic resonance angiography (MRA) for detection and assessment of stenosis in patients with autologuous hemodialysis access.
  
  
  METHODS
  Search of PubMed, MEDLINE, EMBASE and Cochrane Library database from January 1984 to May 2013 for studies comparing CTA or MRA with DSA or surgery for autologuous hemodialysis access. Eligible studies were in English language, aimed to detect more than 50% stenosis or occlusion of autologuous vascular access in hemodialysis patients with CTA and MRA technology and provided sufficient data about diagnosis performance. Methodological quality was assessed by the Quality Assessment of Diagnostic Studies (QUADAS) instrument. Sensitivities (SEN), specificities (SPE), positive likelihood ratio (PLR), negative likelihood values (NLR), diagnostic odds ratio (DOR) and areas under the receiver operator characteristic curve (AUC) were pooled statistically. Potential threshold effect, heterogeneity and publication bias was evaluated. The clinical utility of CTA and MRA in detection of stenosis was also investigated.
  
  
  RESULTS
  Sixteen eligible studies were included, with a total of 500 patients. Both CTA and MRA were accurate modality (sensitivity, 96.2% and 95.4%, respectively; specificity, 97.1 and 96.1%, respectively; DOR [diagnostic odds ratio], 393.69 and 211.47, respectively) for hemodialysis vascular access. No significant difference was detected between the diagnostic performance of CTA (AUC, 0.988) and MRA (AUC, 0.982). Meta-regression analyses and subgroup analyses revealed no statistical difference. The Deek's funnel plots suggested a publication bias.
  
  
  CONCLUSIONS
  Diagnostic performance of CTA and MRA for detecting stenosis of hemodialysis vascular access had no statistical difference. Both techniques may function as an alternative or an important complement to conventional digital subtraction angiography (DSA) and may be able to help guide medical management.
authors.affiliation: Department of Radiology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Bin
authors.initials: B
authors.lastname: Li
authors.forename: Qiong
authors.initials: Q
authors.lastname: Li
authors.forename: Cong
authors.initials: C
authors.lastname: Chen
authors.forename: Yu
authors.initials: Y
authors.lastname: Guan
authors.forename: Shiyuan
authors.initials: S
authors.lastname: Liu
mesh_terms: D003251:Constriction, Pathologic / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D018810:Magnetic Resonance Angiography / Q000379:methods*; D016017:Odds Ratio; D017594:Publication Bias; D012044:Regression Analysis; D006435:Renal Dialysis / Q000295:instrumentation*; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*; D062666:Vascular Access Devices / Q000009:adverse effects*