1 Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea.
2 Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
AJR Am J Roentgenol. 2018 Jan;210(1):91-100. doi: 10.2214/AJR.17.18480. Epub 2017 Sep 27.
The purpose of this study was to perform a head-to-head comparison between high-b-value (> 1000 s/mm) and standard-b-value (800-1000 s/mm) DWI regarding diagnostic performance in the detection of prostate cancer.
The MEDLINE and EMBASE databases were searched up to April 1, 2017. The analysis included diagnostic accuracy studies in which high- and standard-b-value DWI were used for prostate cancer detection with histopathologic examination as the reference standard. Methodologic quality was assessed with the revised Quality Assessment of Diagnostic Accuracy Studies tool. Sensitivity and specificity of all studies were calculated and were pooled and plotted in a hierarchic summary ROC plot. Meta-regression and multiple-subgroup analyses were performed to compare the diagnostic performances of high- and standard-b-value DWI.
Eleven studies (789 patients) were included. High-b-value DWI had greater pooled sensitivity (0.80 [95% CI, 0.70-0.87]) (p = 0.03) and specificity (0.92 [95% CI, 0.87-0.95]) (p = 0.01) than standard-b-value DWI (sensitivity, 0.78 [95% CI, 0.66-0.86]); specificity, 0.87 [95% CI, 0.77-0.93] (p < 0.01). Multiple-subgroup analyses showed that specificity was consistently higher for high- than for standard-b-value DWI (p ≤ 0.05). Sensitivity was significantly higher for high- than for standard-b-value DWI only in the following subgroups: peripheral zone only, transition zone only, multiparametric protocol (DWI and T2-weighted imaging), visual assessment of DW images, and per-lesion analysis (p ≤ 0.04).
In a head-to-head comparison, high-b-value DWI had significantly better sensitivity and specificity for detection of prostate cancer than did standard-b-value DWI. Multiple-subgroup analyses showed that specificity was consistently superior for high-b-value DWI.
本研究旨在对头颈比较高 b 值 (>1000 s/mm) 和标准 b 值 (800-1000 s/mm) 弥散加权成像在前列腺癌检测中的诊断性能。
检索 MEDLINE 和 EMBASE 数据库，截至 2017 年 4 月 1 日。分析包括使用高和标准 b 值 DWI 检测前列腺癌的诊断准确性研究，以组织病理学检查为参考标准。采用改良的诊断准确性研究质量评估工具评估方法学质量。计算所有研究的敏感性和特异性，并在层次汇总 ROC 图中进行汇总和绘制。进行荟萃回归和多亚组分析比较高和标准 b 值 DWI 的诊断性能。
共纳入 11 项研究 (789 例患者)。高 b 值 DWI 的 pooled 敏感性 (0.80 [95%CI，0.70-0.87]) (p = 0.03) 和特异性 (0.92 [95%CI，0.87-0.95]) (p = 0.01) 均高于标准 b 值 DWI (敏感性，0.78 [95%CI，0.66-0.86]）；特异性，0.87 [95%CI，0.77-0.93] (p < 0.01)。多亚组分析显示，高 b 值 DWI 的特异性始终高于标准 b 值 DWI (p ≤ 0.05)。高 b 值 DWI 的敏感性显著高于标准 b 值 DWI 仅在以下亚组中：仅外周区、仅移行区、多参数方案 (DWI 和 T2 加权成像)、DW 图像的视觉评估和每病变分析 (p ≤ 0.04)。
在头对头比较中，高 b 值 DWI 对前列腺癌的检测具有显著更高的敏感性和特异性，优于标准 b 值 DWI。多亚组分析显示，高 b 值 DWI 的特异性始终优于标准 b 值 DWI。
