全身扩散加权磁共振成像对原发性和转移性恶性肿瘤检测的诊断价值：一项荟萃分析。
Diagnostic value of whole-body diffusion-weighted magnetic resonance imaging for detection of primary and metastatic malignancies: a meta-analysis.
机构信息
Department of Radiology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai 200003, China.
Department of Radiology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai 200003, China.
出版信息
Eur J Radiol. 2014 Feb;83(2):338-44. doi: 10.1016/j.ejrad.2013.11.017. Epub 2013 Dec 4.
PURPOSE
To perform a meta-analysis to evaluate the diagnostic performance of whole-body diffusion-weighted magnetic resonance imaging (WB-DWI) technique in detection of primary and metastatic malignancies compared with that of whole-body positron emission tomography/computed tomography (WB-PET/CT).
MATERIALS AND METHODS
Search Pubmed, MEDLINE, EMBASE and Cochrane Library database from January 1984 to July 2013 for studies comparing WB-DWI with WB-PET/CT for detection of primary and metastatic malignancies. Methodological quality was assessed by the quality assessment of diagnostic studies (QUADAS) instrument. Sensitivities, specificities, predictive values, diagnostic odds ratio (DOR) and areas under the summary receiver operator characteristic curve (AUC) were calculated. Potential threshold effect, heterogeneity and publication bias were investigated.
RESULT
Thirteen eligible studies were included, with a total of 1067 patients. There was no significant threshold effect. WB-DWI had a similar AUC (0.966 (95% CI, 0.940-0.992) versus 0.984 (95% CI, 0.965-0.999)) with WB-PET/CT. No significant difference was detected between AUC of WB-DWI and WB-PET/CT. WB-DWI had a pooled sensitivity of 0.897 (95% CI, 0.876-0.916) and a pooled specificity of 0.954 (95% CI, 0.944-0.962). WB-PET/CT had a pooled sensitivity of 0.895 (95% CI, 0.865-0.920) and a pooled specificity of 0.975 (95% CI, 0.966-0.981). Heterogeneity was found to stem primarily from data type (per lesion versus per patient), MR sequence (DWIBS only and DWIBS with other sequence), and primary lesion type (single type and multiple type). The Deeks's funnel plots suggested the absence of publication bias.
CONCLUSION
WB-DWI has similar, good diagnostic performance for the detection of primary and metastatic malignancies compared with WB-PET/CT. DWIBS with other MR sequences could further improve the diagnostic performance. More high-quality studies regarding comparison of WB-DWI and WB-PET/CT and combination of them in detecting malignancies are still needed to be conducted.
目的
进行荟萃分析，以评估全身扩散加权磁共振成像（WB-DWI）技术与全身正电子发射断层扫描/计算机断层扫描（WB-PET/CT）相比在检测原发性和转移性恶性肿瘤方面的诊断性能。
材料与方法
从 1984 年 1 月至 2013 年 7 月，检索 Pubmed、MEDLINE、EMBASE 和 Cochrane Library 数据库，以比较 WB-DWI 与 WB-PET/CT 检测原发性和转移性恶性肿瘤的研究。使用诊断研究质量评估工具（QUADAS）评估方法学质量。计算敏感度、特异度、预测值、诊断比值比（DOR）和汇总受试者工作特征曲线下面积（AUC）。评估潜在的阈值效应、异质性和发表偏倚。
结果
共纳入 13 项符合条件的研究，共计 1067 例患者。无显著阈值效应。WB-DWI 与 WB-PET/CT 相比，AUC 相似（0.966（95%CI，0.940-0.992）与 0.984（95%CI，0.965-0.999））。未检测到 WB-DWI 和 WB-PET/CT 的 AUC 之间存在显著差异。WB-DWI 的敏感度为 0.897（95%CI，0.876-0.916），特异度为 0.954（95%CI，0.944-0.962）。WB-PET/CT 的敏感度为 0.895（95%CI，0.865-0.920），特异度为 0.975（95%CI，0.966-0.981）。异质性主要源于数据类型（每病灶与每患者）、MR 序列（仅 DWIBS 与 DWIBS 联合其他序列）和原发性病变类型（单类型与多类型）。Deeks 漏斗图提示无发表偏倚。
结论
与 WB-PET/CT 相比，WB-DWI 对原发性和转移性恶性肿瘤的检测具有相似的良好诊断性能。DWIBS 联合其他 MR 序列可进一步提高诊断性能。仍需要开展更多关于 WB-DWI 与 WB-PET/CT 比较以及联合应用于恶性肿瘤检测的高质量研究。
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