扩散加权成像鉴别良恶性胆囊病变的诊断性能：系统评价和荟萃分析。
Diagnostic performance of diffusion-weighted imaging for differentiating benign and malignant gallbladder lesions: A systematic review and meta-analysis.
机构信息
Department of Radiology, Kyung Hee University Hospital, Dongdaemun-gu, Seoul, Republic of Korea.
Department of Radiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Gangdong-gu, Seoul, Republic of Korea.
出版信息
J Magn Reson Imaging. 2018 Nov;48(5):1375-1388. doi: 10.1002/jmri.26035. Epub 2018 Apr 20.
BACKGROUND
Although diffusion-weighted imaging (DWI) has been characterized as an alternative imaging modality for gallbladder (GB) lesions, it has not been routinely used in clinical practice because of relatively low signal-to-noise ratio.
PURPOSE
To assess the sensitivity and specificity of the diagnostic performance of DWI for differentiating benign and malignant GB lesions.
STUDY TYPE
Meta-analysis.
POPULATION
Patients with GB lesions.
FIELD STRENGTH/SEQUENCE: DWI at 3.0T or 1.5T.
ASSESSMENT
PubMed and EMBASE were searched following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses of Diagnostic Test Accuracy guidelines.
STATISTICAL TESTS
Bivariate modeling and hierarchical summary receiver operating characteristic (HSROC) modeling were performed to compare the overall diagnostic performance of DWI. Subgroup analyses were performed for qualitative and quantitative assessment of the DWI. Meta-regression analyses were performed according to the characteristics of the patients, study, and MRI.
RESULTS
Eight studies (including 557 patients) were included. The DWI exhibited a pooled sensitivity of 91%, a pooled specificity of 87%, and HSROC of 0.95. In subgroup analyses, qualitative assessment (sensitivity, 90%; specificity, 87%; HSROC, 0.94) was more accurate than quantitative assessment (sensitivity, 82%; specificity, 86 %; HSROC, 0.88). On meta-regression analysis, studies that used 3.0T field strength and thinner slices (≤5 mm) reported a significantly higher sensitivity (P ≤ 0.02) than those using only 1.5T field strength and thicker slices (>5 mm).
DATA CONCLUSION
DWI can discriminate malignant from benign GB lesions with excellent diagnostic performance in both qualitative and quantitative assessments. To enhance the diagnostic ability of DWI, images obtained with thinner slices (≤5 mm) with 3T field strength and qualitative assessment are recommended.
LEVEL OF EVIDENCE
3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018;47:1375-1388.
背景
尽管扩散加权成像（DWI）已被描述为胆囊（GB）病变的另一种成像方式，但由于其信噪比相对较低，因此尚未常规用于临床实践。
目的
评估 DWI 对鉴别胆囊良恶性病变的诊断性能的灵敏度和特异性。
研究类型
荟萃分析。
人群
胆囊病变患者。
磁场强度/序列：3.0T 或 1.5T 的 DWI。
评估
根据系统评价和诊断测试准确性的首选报告项目指南，在 PubMed 和 EMBASE 上进行了搜索。
统计检验
使用双变量建模和分层综合接收者操作特征（HSROC）建模来比较 DWI 的整体诊断性能。对 DWI 的定性和定量评估进行了亚组分析。根据患者、研究和 MRI 的特点进行了荟萃回归分析。
结果
纳入了 8 项研究（共 557 例患者）。DWI 的总体敏感度为 91%，总体特异性为 87%，HSROC 为 0.95。在亚组分析中，定性评估（敏感度 90%，特异性 87%，HSROC 0.94）比定量评估（敏感度 82%，特异性 86%，HSROC 0.88）更准确。荟萃回归分析显示，使用 3.0T 场强和更薄的切片（≤5mm）的研究报告的敏感度显著更高（P≤0.02），而仅使用 1.5T 场强和较厚的切片（>5mm）的研究报告的敏感度则较低。
数据结论
DWI 可以区分胆囊的良恶性病变，在定性和定量评估中均具有出色的诊断性能。为了提高 DWI 的诊断能力，建议使用 3T 场强和更薄的切片（≤5mm）进行图像采集，并进行定性评估。
证据水平
3 级技术功效：2 级。J. Magn. Reson. Imaging 2018;47:1375-1388.
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