Department of Radiology, Assistance Publique-Hôpitaux de Paris, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France.
University Paris Diderot, Sorbonne Paris Cité, Paris, France.
Eur Radiol. 2016 Dec;26(12):4595-4615. doi: 10.1007/s00330-016-4250-5. Epub 2016 Feb 16.
To obtain the diagnostic performance of diffusion-weighted (DW) and gadoxetic-enhanced magnetic resonance (MR) imaging in the detection of liver metastases.
A comprehensive search (EMBASE, PubMed, Cochrane) was performed to identify relevant articles up to June 2015. Inclusion criteria were: liver metastases, DW-MR imaging and/or gadoxetic acid-enhanced MR imaging, and per-lesion statistics. The reference standard was histopathology, intraoperative observation and/or follow-up. Sources of bias were assessed using the QUADAS-2 tool. A linear mixed-effect regression model was used to obtain sensitivity estimates.
Thirty-nine articles were included (1,989 patients, 3,854 metastases). Sensitivity estimates for DW-MR imaging, gadoxetic acid-enhanced MR imaging and the combined sequence for detecting liver metastases on a per-lesion basis was 87.1 %, 90.6 % and 95.5 %, respectively. Sensitivity estimates by gadoxetic acid-enhanced MR imaging and the combined sequence were significantly better than DW-MR imaging (p = 0.0001 and p < 0.0001, respectively), and the combined MR sequence was significantly more sensitive than gadoxetic acid-enhanced MR imaging (p < 0.0001). Similar results were observed in articles that compared the three techniques simultaneously, with only colorectal liver metastases and in liver metastases smaller than 1 cm.
In patients with liver metastases, combined DW-MR and gadoxetic acid-enhanced MR imaging has the highest sensitivity for detecting liver metastases on a per-lesion basis.
• DW-MRI is less sensitive than gadoxetic acid-enhanced MRI for detecting liver metastases • DW-MRI and gadoxetic acid-enhanced MRI is the best combination • Same results are observed in colorectal liver metastases • Same results are observed in liver metastases smaller than 1 cm • Same results are observed when histopathology alone is the reference standard.
评估弥散加权（DW）和钆塞酸增强磁共振（MR）成像在肝脏转移瘤检测中的诊断性能。
全面检索 EMBASE、PubMed 和 Cochrane 数据库，收集截至 2015 年 6 月有关 DW-MRI 和/或钆塞酸增强 MRI 检测肝脏转移瘤的研究。纳入标准：肝脏转移瘤，DW-MRI 和/或钆塞酸增强 MRI 检查，以每个病灶为单位进行统计。参考标准为组织病理学、术中观察和/或随访。使用 QUADAS-2 工具评估偏倚来源。采用线性混合效应回归模型计算敏感性估计值。
共纳入 39 篇文献（1989 例患者，3854 个病灶）。DW-MRI、钆塞酸增强 MRI 及联合序列对肝脏转移瘤的检出敏感性估计值分别为 87.1%、90.6%和 95.5%。与 DW-MRI 相比，钆塞酸增强 MRI 和联合序列的敏感性均显著提高（p=0.0001 和 p<0.0001），且联合序列的敏感性明显优于钆塞酸增强 MRI（p<0.0001）。在同时比较三种技术、仅包含结直肠癌肝转移或转移灶直径<1cm 的研究中也观察到类似结果。
在肝脏转移瘤患者中，DW-MRI 联合钆塞酸增强 MRI 对肝脏转移瘤的检出敏感性最高。
• DW-MRI 对肝脏转移瘤的检出敏感性低于钆塞酸增强 MRI • DW-MRI 联合钆塞酸增强 MRI 为最佳组合 • 在结直肠癌肝转移和转移灶直径<1cm 中也观察到类似结果 • 在以组织病理学为参考标准时也观察到类似结果
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