扩散加权磁共振成像与氟代脱氧葡萄糖正电子发射断层扫描/计算机断层扫描对胰腺恶性肿瘤的诊断价值：使用层次回归模型的荟萃分析。
Diagnostic value of diffusion-weighted magnetic resonance imaging compared with fluorodeoxyglucose positron emission tomography/computed tomography for pancreatic malignancy: a meta-analysis using a hierarchical regression model.
机构信息
Department of Radiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
出版信息
J Gastroenterol Hepatol. 2012 Jun;27(6):1027-35. doi: 10.1111/j.1440-1746.2012.07112.x.
BACKGROUND AND AIM
To obtain diagnostic performance of diffusion-weighted magnetic resonance imaging (DWI) and fluorine 18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) in the detection of pancreatic malignancy.
METHODS
We performed a meta-analysis of all available studies of the diagnostic performance of DWI and PET/CT for pancreatic malignancy. MEDLINE, EMBASE, Cochrane library and some other databases were searched for initial studies. We determined sensitivities and specificities across studies, calculated positive and negative likelihood ratios (LR+ and LR-), and constructed summary receiver operating characteristic curves (SROC) using hierarchical regression models.
RESULTS
Across 16 studies with 804 patients, PET/CT sensitivity was 0.87 (95% confidence interval [CI], 0.82, 0.81) and specificity was 0.83 (95% CI, 0.71, 0.91). Overall, LR+ was 5.84 (95% CI, 4.59, 7.42) and LR- was 0.24 (95% CI, 0.17, 0.33). DWI sensitivity was 0.85 (95% CI, 0.74, 0.92) and specificity was 0.91 (95% CI, 0.71, 0.98). LR+ was 9.53 (95% CI, 2.41, 37.65) and LR- was 0.17 (95% CI, 0.09, 0.32). In subgroup analysis, the sensitivity of enhanced versus unenhanced PET/CT in the detection of pancreatic cancer was 0.91 (95% CI, 0.86, 0.96) versus 0.84 (95% CI, 0.78, 0.90) (P > 0.05), the specificity 0.88 (95% CI, 0.73, 1.00) versus 0.81 (95% CI, 0.69, 0.94) (P > 0.05).
CONCLUSION
Positron emission tomography/computed tomography (PET/CT) was highly sensitive and DWI was a highly specific modality in diagnosing patients with pancreatic malignancy. PET/CT and DWI could play different roles in diagnosing pancreatic carcinoma. Enhanced PET/CT seems to be superior to unenhanced PET/CT. Further larger prospective studies are needed to establish its value for diagnosis in pancreatic cancer.
背景与目的
探讨扩散加权磁共振成像（DWI）和氟 18 氟脱氧葡萄糖（FDG）正电子发射断层扫描/计算机断层扫描（PET/CT）在胰腺恶性肿瘤诊断中的应用价值。
方法
对所有关于 DWI 和 PET/CT 对胰腺恶性肿瘤诊断性能的研究进行了荟萃分析。检索 MEDLINE、EMBASE、Cochrane 图书馆和其他一些数据库，以获取初步研究资料。我们在各个研究之间确定了敏感性和特异性，计算了阳性和阴性似然比（LR+和 LR-），并使用分层回归模型构建了汇总受试者工作特征曲线（SROC）。
结果
纳入 16 项共 804 例患者的研究，结果显示，PET/CT 的敏感性为 0.87（95%可信区间[CI]，0.82，0.81），特异性为 0.83（95%CI，0.71，0.91）。总体而言，LR+为 5.84（95%CI，4.59，7.42），LR-为 0.24（95%CI，0.17，0.33）。DWI 的敏感性为 0.85（95%CI，0.74，0.92），特异性为 0.91（95%CI，0.71，0.98）。LR+为 9.53（95%CI，2.41，37.65），LR-为 0.17（95%CI，0.09，0.32）。在亚组分析中，增强型与非增强型 PET/CT 在胰腺癌检测中的敏感性分别为 0.91（95%CI，0.86，0.96）和 0.84（95%CI，0.78，0.90）（P>0.05），特异性分别为 0.88（95%CI，0.73，1.00）和 0.81（95%CI，0.69，0.94）（P>0.05）。
结论
正电子发射断层扫描/计算机断层扫描（PET/CT）对诊断胰腺恶性肿瘤具有较高的敏感性，而 DWI 则具有较高的特异性。PET/CT 和 DWI 在诊断胰腺癌方面可能发挥不同的作用。增强型 PET/CT 似乎优于非增强型 PET/CT。需要进一步开展更大规模的前瞻性研究以确定其在胰腺癌诊断中的价值。
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