Bipat Shandra, Glas Afina S, van der Velden Jacobus, Zwinderman Aeilko H, Bossuyt Patrick M M, Stoker Jaap
Department of Radiology, G1-230, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
Gynecol Oncol. 2003 Oct;91(1):59-66. doi: 10.1016/s0090-8258(03)00409-8.
The goal of this article is to systematically review the available evidence on the diagnostic performance of computed tomography (CT) and magnetic resonance imaging (MRI) in staging of cervical carcinoma.
A comprehensive computer literature search was performed in MEDLINE and EMBASE databases from January 1985 to May 2002. Two reviewers independently scored methodological quality of included studies and extracted relevant data for data analysis. A bivariate random effect approach was used to summarize estimates of sensitivity and specificity values. Covariates were added to this model to study the influence of sample size, publication year, methodological criteria, and MRI techniques on summary estimates.
Fifty-seven articles were included. In 49 articles one imaging modality was evaluated (MRI, 38; CT, 11), and in 8 articles, both. Inclusion criteria were: minimum of 10 patients included, histopathology as reference standard, sufficient data presented to construct 2(x) 2 tables. The exclusion criterion was: data reported elsewhere in more detail. Sensitivity estimates for parametrial invasion were 74% (95% C: 68-79%) for MRI and 55% (95% CI: 44-66%) for CT, and for lymph node involvement, 60% (95% CI 52%-68%) and 43% (95% CI: 37-57%), respectively. MRI and CT had comparable specificities for parametrial invasion and lymph node involvement. For bladder invasion and rectum invasion the sensitivities for MRI were respectively 75% (95% CI: 66-83%) and 71% (95% CI: 53-83%), higher compared with CT. The specificity in evaluating bladder invasion for MRI was significantly higher compared with CT: 91% (95% CI: 83-95%) for MRI and 73% (95% CI: 52-87%) for CT. The specificities for rectum invasion were comparable. Differences in patient sample size, publication year, methodological criteria, and MRI techniques had no effect on the summary estimates.
For overall staging of cervical carcinoma, MRI is more accurate than CT.
本文旨在系统综述计算机断层扫描（CT）和磁共振成像（MRI）在宫颈癌分期诊断性能方面的现有证据。
对1985年1月至2002年5月期间的MEDLINE和EMBASE数据库进行了全面的计算机文献检索。两名评审员独立对纳入研究的方法学质量进行评分，并提取相关数据进行数据分析。采用双变量随机效应方法汇总敏感性和特异性值的估计。将协变量添加到该模型中，以研究样本量、发表年份、方法学标准和MRI技术对汇总估计的影响。
纳入57篇文章。49篇文章评估了一种成像方式（MRI，38篇；CT，11篇），8篇文章评估了两种成像方式。纳入标准为：至少纳入10例患者，以组织病理学作为参考标准，提供足够的数据以构建2×2表格。排除标准为：在其他地方更详细报道的数据。对于宫旁浸润，MRI的敏感性估计为74%（95%CI：68-79%），CT为55%（95%CI：44-66%）；对于淋巴结受累，分别为60%（95%CI 52%-68%）和43%（95%CI：37-57%）。MRI和CT在宫旁浸润和淋巴结受累方面具有可比的特异性。对于膀胱浸润和直肠浸润，MRI的敏感性分别为75%（95%CI：66-83%）和71%（95%CI：53-83%），高于CT。MRI评估膀胱浸润的特异性显著高于CT：MRI为91%（95%CI：83-95%），CT为73%（95%CI：52-87%）。直肠浸润的特异性相当。患者样本量、发表年份、方法学标准和MRI技术的差异对汇总估计没有影响。
对于宫颈癌的总体分期，MRI比CT更准确。
