CT、钆塞酸二钠增强 MRI 和 PET/CT 诊断结直肠癌肝转移的诊断性能：系统评价和荟萃分析。

Diagnostic performance of CT, gadoxetate disodium-enhanced MRI, and PET/CT for the diagnosis of colorectal liver metastasis: Systematic review and meta-analysis.

机构信息

Department of Radiology and the Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.

National Evidence-based Healthcare Collaborating Agency, Seoul, South Korea.

出版信息

J Magn Reson Imaging. 2018 May;47(5):1237-1250. doi: 10.1002/jmri.25852. Epub 2017 Sep 13.

DOI:10.1002/jmri.25852

PMID:28901685

Abstract

BACKGROUND

Imaging studies, including computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET), have an essential role in the detection and localization of colorectal liver metastasis (CRLM).

PURPOSE

To systematically determine the diagnostic accuracy of multidetector row CT (MDCT), gadoxetate disodium-enhanced MRI, and PET/CT for diagnosing CRLM and the sources of heterogeneity between the reported results.

STUDY TYPE

Systematic review and meta-analysis.

SUBJECTS

In all, 2151 lesions in CT studies, 2301 lesions in MRI studies, 1846 lesions in PET/CT studies, FIELD STRENGTH: 1.5T and 3.0T.

ASSESSMENT

We identified research studies that investigated MDCT, gadoxetate disodium-enhanced MRI, and PET/CT to diagnose CRLM by performing a systematic search of PubMed MEDLINE and EMBASE. Study quality was assessed using Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2).

STATISTICAL TESTS

According to the types of imaging tests, study heterogeneity and the threshold effect were analyzed and the meta-analytic summary of sensitivity and specificity were estimated. Meta-regression analysis was performed to further investigate study heterogeneity.

RESULTS

Of the 860 articles screened, we found 36 studies from 24 articles reporting a diagnosis of CRLM (11 CT studies, 12 MRI studies, and 13 PET/CT studies). The meta-analytic summary sensitivity for CT, MRI, and PET/CT were 82.1% (95% confidence interval [CI], 74.0-88.1%), 93.1% (95% CI, 88.4-96.0%), and 74.1% (95% CI, 62.1-83.3%), respectively. The meta-analytic summary specificity for CT, MRI, and PET/CT were 73.5% (95% CI, 53.7-86.9%), 87.3% (95% CI, 77.5-93.2%), and 93.9% (95% CI, 83.9-97.8%), respectively. There was no threshold effect in any of the imaging tests. Neoadjuvant chemotherapy significantly decreased the sensitivity of CT and MRI (P < 0.01), although it did not significantly affect the sensitivity of PET/CT. The study design, type of reference standard, and study quality also affected the diagnostic performances of imaging studies.

DATA CONCLUSION

Despite the heterogeneous accuracy between studies, gadoxetate disodium-enhanced MRI showed the highest sensitivity, and gadoxetate disodium-enhanced MRI and PET/CT had similar specificities for diagnosing CRLM.

LEVEL OF EVIDENCE

3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018;47:1237-1250.

摘要

背景

影像学研究，包括计算机断层扫描（CT）、磁共振成像（MRI）和正电子发射断层扫描（PET），在结直肠癌肝转移（CRLM）的检测和定位中具有重要作用。

目的

系统确定多排 CT（MDCT）、钆塞酸二钠增强 MRI 和 PET/CT 诊断 CRLM 的诊断准确性，并确定报告结果之间异质性的来源。

研究类型

系统评价和荟萃分析。

受试者

共 2151 个 CT 研究中的病变，2301 个 MRI 研究中的病变，1846 个 PET/CT 研究中的病变，场强：1.5T 和 3.0T。

评估

我们通过对 PubMed MEDLINE 和 EMBASE 进行系统搜索，确定了研究 MDCT、钆塞酸二钠增强 MRI 和 PET/CT 以诊断 CRLM 的研究。使用诊断准确性研究质量评估工具（QUADAS-2）评估研究质量。

统计检验

根据影像学检查的类型、研究异质性和阈值效应进行分析，并估计敏感性和特异性的荟萃分析总结。进行了荟萃回归分析以进一步研究研究异质性。

结果

在筛选的 860 篇文章中，我们从 24 篇文章中找到了 36 项研究，这些研究报告了 CRLM 的诊断（11 项 CT 研究、12 项 MRI 研究和 13 项 PET/CT 研究）。CT、MRI 和 PET/CT 的荟萃分析汇总敏感性分别为 82.1%（95%置信区间 [CI]，74.0-88.1%）、93.1%（95% CI，88.4-96.0%）和 74.1%（95% CI，62.1-83.3%），特异性分别为 73.5%（95% CI，53.7-86.9%）、87.3%（95% CI，77.5-93.2%）和 93.9%（95% CI，83.9-97.8%）。任何影像学检查均无阈值效应。新辅助化疗显著降低了 CT 和 MRI 的敏感性（P < 0.01），尽管它对 PET/CT 的敏感性没有显著影响。研究设计、参考标准类型和研究质量也影响了影像学研究的诊断性能。