Yang Mo, Sun James, Bai Harrison X, Tao Yongguang, Tang Xiangqi, States Lisa J, Zhang Zishu, Zhou Jianhua, Farwell Michael D, Zhang Paul, Xiao Bo, Yang Li
Department of Neurology, The Second Xiangya Hospital, Changsha City, Hunan Province, China Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA Cancer Research Institute, Central South University, Changsha City, Hunan Province, China Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA Department of Radiology, The Second Xiangya Hospital Department of Pathology, The First Xiangya Hospital, Changsha City, Hunan Province, China Department of Pathology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA Department of Neurology, The First Xiangya Hospital, Changsha City, Hunan Province, China.
Medicine (Baltimore). 2017 May;96(19):e6676. doi: 10.1097/MD.0000000000006676.
We performed a systematic review and meta-analysis to assess the roles of SPECT, PET, and MRS in distinguishing primary central nervous system lymphoma (PCNSL) from other focal brain lesions (FBLs) in human immunodeficiency virus (HIV)-infected patients.
PubMed, Scopus, and Medline were systematically searched for eligible studies from 1980 to 2016. Two authors extracted characteristics of patients and their lesions using predefined criteria.
Eighteen studies on SPECT containing 667 patients, 6 studies on PET containing 108 patients, and 3 studies on MRS containing 96 patients were included. SPECT had a pooled sensitivity of 0.92 (95% CI: 0.85-0.96) and specificity of 0.84 (95% CI: 0.74-0.90) in differentiating PCNSL from other FBLs. For the 6 studies that used only pathology and/or serology as the gold standard, the pooled sensitivity was 0.85 (95% CI: 0.72-0.97) and the pooled specificity was 0.73 (95% CI: 0.54-0.92).
SPECT has good diagnostic accuracy for discriminating PCNSL from other FBL-causing disorders in HIV patients. However, the actual sensitivity and specificity of SPECT may be lower than expected if only pathology and/or serology was used as the gold standard. PET may be superior but has less supporting clinical data and is more expensive.
我们进行了一项系统评价和荟萃分析，以评估单光子发射计算机断层扫描（SPECT）、正电子发射断层扫描（PET）和磁共振波谱（MRS）在区分人类免疫缺陷病毒（HIV）感染患者的原发性中枢神经系统淋巴瘤（PCNSL）与其他局灶性脑病变（FBL）中的作用。
系统检索了PubMed、Scopus和Medline数据库中1980年至2016年的符合条件的研究。两名作者使用预定义标准提取患者及其病变的特征。
纳入了18项关于SPECT的研究，共667例患者；6项关于PET的研究，共108例患者；3项关于MRS的研究，共96例患者。在区分PCNSL与其他FBL方面，SPECT的合并敏感度为0.92（95%置信区间：0.85-0.96），特异度为0.84（95%置信区间：0.74-0.90）。对于仅使用病理和/或血清学作为金标准的6项研究，合并敏感度为0.85（95%置信区间：0.72-0.97），合并特异度为0.73（95%置信区间：0.54-0.92）。
SPECT在鉴别HIV患者的PCNSL与其他引起FBL的疾病方面具有良好的诊断准确性。然而，如果仅将病理和/或血清学用作金标准，SPECT的实际敏感度和特异度可能低于预期。PET可能更具优势，但支持的临床数据较少且费用更高。
