Department of Radiology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, No. 1630, Dongfang Road, Pudong, Shanghai 200127, China.
Magn Reson Imaging. 2013 Feb;31(2):235-46. doi: 10.1016/j.mri.2012.07.009. Epub 2012 Aug 16.
Recent developments in diffusion-weighted magnetic resonance imaging (DWI) make it possible to image malignant tumors to provide tissue contrast based on difference with the diffusion of water molecules among tissues, which can be measured by the apparent diffusion coefficient (ADC) value. We aimed to assess the diagnostic accuracy of DWI for benign/malignant discrimination of pulmonary nodules/masses with a meta-analysis. The MEDLINE, EMBASE, Cancerlit and Cochrane Library database, from January 2001 to August 2011, were searched for studies evaluating the diagnostic accuracy of DWI for benign/malignant discrimination of pulmonary nodules. We determined sensitivities and specificities across studies, calculated positive and negative likelihood ratios (LRP and LRN), and constructed summary receiver operating characteristic SROC) curves. Across 10 studies (545 patients), there was no evidence of publication bias (P=.22, bias=-19.19). DWI had a pooled sensitivity of 0.84 (95% CI, 0.76-0.90) and a pooled specificity of 0.84 (95% CI, 0.64-0.94). Overall, LRP was 5.3 (95% CI, 2.1-13.0) and LRN was 0.19 (95% CI, 0.12-0.30). In patients with high pretest probabilities, DWI enabled confirmation of malignant pulmonary lesion; in patients with low pretest probabilities, DWI enabled exclusion of malignant pulmonary lesion. Worst-case-scenario (pretest probability, 50%) posttest probabilities were 84% and 16% for positive and negative DWI results, respectively. Diffusion-weighted magnetic resonance imaging can be used to differentiate malignant from benign pulmonary lesions. High-quality prospective studies regarding DWI in the evaluation of pulmonary nodules are still needed to be conducted.
磁共振弥散加权成像（DWI）的最新进展使得对恶性肿瘤进行成像成为可能，根据水分子在组织间扩散的差异提供组织对比，这可以通过表观弥散系数（ADC）值来测量。我们旨在通过荟萃分析评估 DWI 对肺结节/肿块良恶性鉴别诊断的准确性。我们检索了 MEDLINE、EMBASE、Cancerlit 和 Cochrane Library 数据库，检索时间为 2001 年 1 月至 2011 年 8 月，以评估 DWI 对肺结节良恶性鉴别诊断的准确性的研究。我们确定了研究之间的敏感性和特异性，计算了阳性和阴性似然比（LRP 和 LRN），并构建了汇总受试者工作特征（SROC）曲线。在 10 项研究（545 例患者）中，没有证据表明存在发表偏倚（P=.22，偏倚=-19.19）。DWI 的汇总敏感性为 0.84（95%CI，0.76-0.90），汇总特异性为 0.84（95%CI，0.64-0.94）。总的来说，LRP 为 5.3（95%CI，2.1-13.0），LRN 为 0.19（95%CI，0.12-0.30）。在术前概率较高的患者中，DWI 能够确认恶性肺病变；在术前概率较低的患者中，DWI 能够排除恶性肺病变。最差情况（术前概率，50%）的 DWI 阳性和阴性结果的术后概率分别为 84%和 16%。弥散加权磁共振成像可用于鉴别恶性和良性肺病变。仍需要开展关于 DWI 在肺结节评估中的高质量前瞻性研究。
