State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Clin Radiol. 2013 Mar;68(3):e143-53. doi: 10.1016/j.crad.2012.11.002. Epub 2012 Dec 11.
To explore the role of magnetic resonance imaging (MRI) in detecting bone marrow infiltration of malignant lymphoma through a systematic review and meta-analysis.
Studies that evaluated the diagnostic performance of MRI in detecting bone marrow infiltration of malignant lymphoma were acquired from the MEDLINE, EMBASE, Cancerlit, and Cochrane Library database, from February 1987 to May 2012. Pooled estimation and subgroup analysis data were obtained by statistical analysis.
A total of 13 studies involving 634 patients who fulfilled all of the inclusion criteria were considered for the analysis. No publication bias was found (p = 0.70). The pooled sensitivity of MRI was 0.82 [95% confidence intervals (CI): 0.70-0.90] and the pooled specificity was 0.79 (95% CI: 0.72-0.84). Overall, positive likelihood ratios (LR+) was 3.9 (95% CI: 2.8-5.4) and negative likelihood ratios (LR-) was 0.23 (95% CI: 0.13-0.41). In patients with high pre-test probabilities, MRI enabled confirmation of bone marrow involvement; in patients with low pre-test probabilities, MRI enabled exclusion of bone marrow involvement. Worst-case-scenario (pre-test probability, 50%) post-test probabilities were 80% and 18% for positive and negative MRI results, respectively. In subgroup analysis, MRI performed with 1.5 T devices had higher pooled specificity (0.80, 95% CI: 0.71-0.88) than the MRI with ≤1 T (0.78, 95% CI: 0.71-0.85; p < 0.05). The pooled sensitivity of MRI with diffusion-weighted imaging (DWI) was 0.65 (95% CI: 0.39-0.92) and the pooled specificity was 0.83 (95% CI: 0.69-0.97). The sensitivity and specificity of MRI without DWI was 0.85 (95% CI: 0.76-0.94) and 0.79 (95% CI: 0.72-0.85), respectively.
A limited number of small studies indicate that MRI can serve as a valuable tool for detecting bone marrow infiltration of malignant lymphoma. Results were most promising when performing MRI using high field strength devices. MRI with DWI is shown to be more specific than conventional MRI techniques. This deserves further investigation in future studies.
通过系统评价和荟萃分析探讨磁共振成像（MRI）在检测恶性淋巴瘤骨髓浸润中的作用。
从 1987 年 2 月至 2012 年 5 月，我们从 MEDLINE、EMBASE、Cancerlit 和 Cochrane Library 数据库中获取了评估 MRI 检测恶性淋巴瘤骨髓浸润诊断性能的研究。通过统计分析获得汇总估计和亚组分析数据。
共有 13 项研究符合所有纳入标准，共涉及 634 名患者。未发现发表偏倚（p = 0.70）。MRI 的汇总敏感性为 0.82（95%置信区间（CI）：0.70-0.90），特异性为 0.79（95%CI：0.72-0.84）。总体而言，阳性似然比（LR+）为 3.9（95%CI：2.8-5.4），阴性似然比（LR-）为 0.23（95%CI：0.13-0.41）。在高预测试概率的患者中，MRI 可确认骨髓受累；在低预测试概率的患者中，MRI 可排除骨髓受累。在最糟糕的情况下（预测试概率为 50%），MRI 阳性和阴性结果的后测试概率分别为 80%和 18%。在亚组分析中，使用 1.5 T 设备的 MRI 具有较高的汇总特异性（0.80，95%CI：0.71-0.88），而≤1 T 的 MRI 具有较低的汇总特异性（0.78，95%CI：0.71-0.85；p<0.05）。使用弥散加权成像（DWI）的 MRI 的汇总敏感性为 0.65（95%CI：0.39-0.92），特异性为 0.83（95%CI：0.69-0.97）。未使用 DWI 的 MRI 的敏感性和特异性分别为 0.85（95%CI：0.76-0.94）和 0.79（95%CI：0.72-0.85）。
少数小型研究表明，MRI 可作为检测恶性淋巴瘤骨髓浸润的一种有价值的工具。当使用高场强设备进行 MRI 时，结果最有希望。与常规 MRI 技术相比，DWI 联合 MRI 的特异性更高。这值得在未来的研究中进一步探讨。
