Kim Hyun-Jung, Lee So-Yeon, Shin Yu Ri, Park Chang Suk, Kim Kijun
Department of Preventive Medicine, College of Medicine, Korea University, Seoul, Korea.
Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
PLoS One. 2016 Feb 23;11(2):e0149465. doi: 10.1371/journal.pone.0149465. eCollection 2016.
The ability of contrast-enhanced MRI to distinguish between malignant and benign ovarian masses is limited. The aim of this meta-analysis is to evaluate the diagnostic performance of diffusion-weighted imaging (DWI) in differentiating malignant from benign ovarian masses.
A comprehensive literature search was performed in several authoritative databases to identify relevant articles. The weighted mean difference (WMD) and corresponding 95% confidence interval (95% CI) were calculated. We also used subgroup analysis to analyze study heterogeneity, and evaluated publication bias.
The meta-analysis is based on 21 studies, which reported the findings for 731 malignant and 918 benign ovarian masses. There was no significant difference in apparent diffusion coefficient (ADC) values for DWI between benign and malignant lesions (WMD = 0.22, 95% CI = -0.02-0.47, p = 0.08). Subgroup analysis by benign tumor type revealed higher ADC values (or a trend toward higher values) for cysts, cystadenomas and other benign tumors compared to malignant masses (cyst: WMD = 0.54, 95% CI = -0.05-1.12, p = 0.07; cystadenoma: WMD = 0.73, 95% CI = 0.38-1.07, p < 0.0001; other benign tumor: WMD = 0.16, 95% CI = -0.13-0.46, p = 0.28). On the other hand, lower ADC values (or a trend toward lower values) were observed for endometrioma and teratoma compared to malignant masses (endometrioma: WMD = -0.09, 95% CI = -0.47-0.29, p = 0.64; teratoma: WMD = -0.49, 95% CI = -0.85-0.12, p = 0.009). Subgroup analysis by mass property revealed higher ADC values in cystic tumor types than in solid types for both benign and malignant tumors. Significant study heterogeneity was observed. There was no notable publication bias.
Quantitative DWI is not a reliable diagnostic method for differentiation between benign and malignant ovarian masses. This knowledge is essential in avoiding misdiagnosis of ovarian masses.
对比增强磁共振成像区分卵巢良恶性肿块的能力有限。本荟萃分析的目的是评估扩散加权成像（DWI）在鉴别卵巢良恶性肿块中的诊断性能。
在多个权威数据库中进行全面的文献检索以识别相关文章。计算加权平均差（WMD）及相应的95%置信区间（95%CI）。我们还采用亚组分析来分析研究的异质性，并评估发表偏倚。
该荟萃分析基于21项研究，这些研究报告了731例恶性和918例良性卵巢肿块的研究结果。良性和恶性病变之间DWI的表观扩散系数（ADC）值无显著差异（WMD = 0.22，95%CI = -0.02 - 0.47，p = 0.08）。按良性肿瘤类型进行的亚组分析显示，与恶性肿块相比，囊肿、囊腺瘤和其他良性肿瘤的ADC值更高（或有升高趋势）（囊肿：WMD = 0.54，95%CI = -0.05 - 1.12，p = 0.07；囊腺瘤：WMD = 0.73，95%CI = 0.38 - 1.07，p < 0.0001；其他良性肿瘤：WMD = 0.16，95%CI = -0.13 - 0.46，p = 0.28）。另一方面，与恶性肿块相比，子宫内膜瘤和畸胎瘤的ADC值较低（或有降低趋势）（子宫内膜瘤：WMD = -0.09，95%CI = -0.47 - 0.29，p = 0.64；畸胎瘤：WMD = -（此处原文有误，应为-）0.49，95%CI = -0.85 - 0.12，p = 0.009）。按肿块性质进行的亚组分析显示，对于良性和恶性肿瘤，囊性肿瘤类型的ADC值均高于实性肿瘤类型。观察到显著的研究异质性。无明显的发表偏倚。
定量DWI不是鉴别卵巢良恶性肿块的可靠诊断方法。这一认识对于避免卵巢肿块的误诊至关重要。
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