DWI联合增强MRI对肝硬化背景下小肝癌诊断价值的Meta分析

陈旭 唐光才 王富林 韩福刚

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DWI联合增强MRI对肝硬化背景下小肝癌诊断价值的Meta分析

    通讯作者: 唐光才, 168345315@qq.com

Diagnostic value of DWI combined enhanced MRI for small hepatocellular carcinoma in patients with cirrhosis: a Meta-analysis

    Corresponding author: Guangcai Tang, 168345315@qq.com ;
  • 摘要: 目的 应用Meta分析评价磁共振弥散加权成像(DWI)联合增强MRI对肝硬化背景下小肝癌的诊断价值。 方法 检索PubMed、Web of Science、中国学术期刊网全文数据库、万方数据库、中文科技期刊数据库(VIP),按纳入和排除标准收集2000年1月至2017年12月的文献。采用诊断性试验质量评价表(QUADAS)进行诊断性试验的评价。使用Meta-Disc 1.4及Stata 12.0软件进行统计学分析,采用χ2检验对各研究的诊断比值比(DOR)进行异质性检验,用I2评估异质性的大小。通过综合受试者工作特征(SROC)曲线及Spearman相关系数检验纳入文献是否存在阈值效应,根据异质性检测结果选择合适的效应模型,通过计算合并灵敏度、特异度、阳性似然比、阴性似然比、DOR、SROC曲线下面积评价DWI联合增强MRI对肝硬化背景下小肝癌的诊断准确率。 结果 共纳入文献7篇,均为英文文献,包含836例患者,共计1112个病灶。异质性I2=76.6%,这表明纳入的文献有高度异质性,Spearman检验r=−0.14(P=0.76),这说明不存在由阈值效应导致的异质性。DWI联合增强MRI对肝硬化背景下小肝癌的诊断价值的合并灵敏度、特异度、阳性似然比、阴性似然比、DOR分别为0.90(95%CI:0.88~0.92)、0.90(95% CI:0.86~0.93)、7.09(95%CI:3.40~14.80)、0.13(95% CI:0.08~0.21)、64.15(95% CI:24.22~169.88)。SROC曲线下面积为0.95。 结论 DWI联合增强MRI对肝硬化背景下小肝癌的诊断具有较高的灵敏度和特异度,可为肝硬化背景下小肝癌的早期诊断及早期治疗提供重要的依据。
  • 图 1  DWI联合增强MRI对肝硬化背景下小肝癌的诊断价值的综合受试者工作特征曲线

    Figure 1.  Summary receiver operating characteristic curve of diagnostic value of DWI combined with enhanced MRI in hepatocellular carcinoma in the background of liver cirrhosis

    图 2  DWI联合增强MRI对肝硬化背景下小肝癌的诊断价值合并灵敏度的森林图

    Figure 2.  Forest map of pooled sensitivity of diagnostic value of DWI combined with enhanced MRI in hepatocellular carcinoma in the background of liver cirrhosis

    图 3  DWI联合增强MRI对肝硬化背景下小肝癌的诊断价值合并特异度的森林图

    Figure 3.  Forest map of pooled specificity of diagnostic value of DWI combined with enhanced MRI in hepatocellular carcinoma in the background of liver cirrhosis

    图 4  DWI联合增强MRI对肝硬化背景下小肝癌的诊断价值合并诊断比值比结果

    Figure 4.  Pooled diagnostic odds ratio of DWI combined with enhanced MRI in hepatocellular carcinoma in the background of liver cirrhosis

    表 1  DWI联合增强MRI对肝硬化背景下小肝癌诊断价值纳入文献的基本特征

    Table 1.  Basic characteristics of the included literatures of diagnostic value of DWI combined with enhanced MRI in hepatocellular carcinoma in the background of liver cirrhosis

    第一作者时间国家研究类型场强(T)b值是否行肝胆期扫描确诊标准样本量(例)病灶数(个)病灶大小(mm)真阳性数(个)假阳性数(个)假阴性数(个)真阴性数(个)
    Le[11]2012法国前瞻1.50、50、400、800病理 62 828~20 584 8 12
    Park[12]2012韩国回顾3.00、100、800病理、影像学2603236~20165414140
    Di[13]2013意大利前瞻1.50、50、400、800病理、影像学 701495~20 73420 52
    Park[14]2013韩国回顾3.00、100、800病理、影像学1481356~201013 1 30
    Zhao[15]2014中国回顾3.00、600病理、影像学 33 545~20 308 4 12
    Chen[16]2014中国回顾1.5500病理、影像学 33 865~30 415 7 33
    Kwon[17]2015韩国回顾1.50、50、500、900病理、影像学2302835~20201921 52
    注:表中,DWI:磁共振弥散加权成像;MRI:磁共振成像。
    下载: 导出CSV

    表 2  DWI联合增强MRI对肝硬化背景下小肝癌诊断价值纳入文献的质量评价结果

    Table 2.  Quality evaluation tables of the included literatures of diagnostic value of DWI combined with enhanced MRI in hepatocellular carcinoma in the background of liver cirrhosis

    第一作者QUADAS条目
    1234567891011121314
    Le[11]
    Park[12]
    Di[13]不确定
    Park[14]
    Zhao[15]不确定
    Chen[16]
    Kwon[17]
    注:表中,1:病例谱是否包含了各种病例及混淆的疾病病例;2:研究对象的选择标准是否明确;3:“金标准”是否能准确区分有病、无病状态;4:“金标准”和待评价试验检测的时间间隔是否足够短,以避免出现疾病病情的变化;5:是否所有的样本或随机选择的样本均接受了“金标准”试验;6:是否所有病例无论评价试验的结果如何,都接受了相同的“金标准”试验;7:“金标准”试验是否独立于待评价试验;8:待评价试验的操作是否描述的足够清楚且可进行重复;9:“金标准”试验的操作是否描述的足够清楚且可进行重复;10:待评价试验的结果判读是否在不知晓“金标准”试验结果的情况下进行的;11:“金标准”试验的结果判读是否在不知晓待评价试验结果的情况下进行的;12:当解释试验结果时可获得的临床资料是否与实际应用中可获得的临床资料一致;13:是否报告了难以解释和(或)中间试验结果;14:对退出研究的病例是否进行了解释。“金标准”为病理结果。DWI:磁共振弥散加权成像;MRI:磁共振成像;QUADAS:诊断性试验质量评价表。
    下载: 导出CSV

    表 3  DWI联合增强MRI对肝硬化背景下小肝癌诊断价值的亚组分析结果

    Table 3.  Results of subgroup analysis of DWI combined with enhanced MRI in hepatocellular carcinoma in the background of liver cirrhosis

    分组因素文献数/篇合并灵敏度(95%CIP合并特异度(95%CIP
    场强0.080.72
     1.5 T40.87(0.83~0.90)0.87(0.81~0.92)
     3.0 T30.94(0.91~0.96)0.92(0.88~0.96)
    是否行肝胆期扫描0.250.44
     否20.87(0.79~0.92)0.83(0.71~0.92)
     是50.91(0.88~0.93)0.91(0.87~0.94)
    样本量0.030.30
     ≥10030.93(0.90~0.95)0.93(0.89~0.96)
     <10040.84(0.79~0.88)0.84(0.76~0.90)
    研究类型0.121.00
     前瞻20.82(0.76~0.88)0.89(0.79~0.95)
     回顾50.92(0.90~0.94)0.90(0.86~0.93)
    研究人群0.121.00
     亚洲组50.92(0.90~0.94)0.90(0.86~0.93)
     非亚洲组20.82(0.76~0.88)0.89(0.79~0.95)
    注:表中,DWI:磁共振弥散加权成像;MRI:磁共振成像。
    下载: 导出CSV
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