Department of First Chemotherapy, Affiliated Tumor Hospital of Guangxi Medical University, Nanning 530021, China.
Department of Therapeutic Radiology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning 530021, China.
Korean J Radiol. 2018 Nov-Dec;19(6):1110-1118. doi: 10.3348/kjr.2018.19.6.1110. Epub 2018 Oct 18.
To perform a meta-analysis to quantitatively assess functional magnetic resonance imaging (MRI) in the diagnosis of locally recurrent prostate cancer.
A comprehensive search of the PubMed, Embase, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews was conducted from January 1, 1995 to December 31, 2016. Diagnostic accuracy was quantitatively pooled for all studies by using hierarchical logistic regression modeling, including bivariate modeling and hierarchical summary receiver operating characteristic (HSROC) curves (AUCs). The Z test was used to determine whether adding functional MRI to T2-weighted imaging (T2WI) results in significantly increased diagnostic sensitivity and specificity.
Meta-analysis of 13 studies involving 826 patients who underwent radical prostatectomy showed a pooled sensitivity and specificity of 91%, and the AUC was 0.96. Meta-analysis of 7 studies involving 329 patients who underwent radiotherapy showed a pooled sensitivity of 80% and specificity of 81%, and the AUC was 0.88. Meta-analysis of 11 studies reporting 1669 sextant biopsies from patients who underwent radiotherapy showed a pooled sensitivity of 54% and specificity of 91%, and the AUC was 0.85. Sensitivity after radiotherapy was significantly higher when diffusion-weighted MRI data were combined with T2WI than when only T2WI results were used. This was true when meta-analysis was performed on a per-patient basis ( = 0.027) or per sextant biopsy ( = 0.046). A similar result was found when H-magnetic resonance spectroscopy (H-MRS) data were combined with T2WI and sextant biopsy was the unit of analysis ( = 0.036).
Functional MRI data may not strengthen the ability of T2WI to detect locally recurrent prostate cancer in patients who have undergone radical prostatectomy. By contrast, diffusion-weight MRI and H-MRS data may improve the sensitivity of T2WI for patients who have undergone radiotherapy.
进行荟萃分析，定量评估功能磁共振成像（fMRI）在诊断局部复发性前列腺癌中的作用。
从 1995 年 1 月 1 日至 2016 年 12 月 31 日，全面检索了 PubMed、Embase、Cochrane 对照试验中心注册库和 Cochrane 系统评价数据库。使用分层逻辑回归模型对所有研究进行定量汇总，包括双变量模型和分层综合受试者工作特征（HSROC）曲线（AUC）。使用 Z 检验确定是否将功能 MRI 加入 T2 加权成像（T2WI）结果可显著提高诊断的敏感性和特异性。
对 13 项涉及 826 例接受根治性前列腺切除术患者的研究进行荟萃分析，结果显示，总体敏感性和特异性分别为 91%，AUC 为 0.96。对 7 项涉及 329 例接受放疗患者的研究进行荟萃分析，结果显示，总体敏感性为 80%，特异性为 81%，AUC 为 0.88。对 11 项报道 1669 例接受放疗患者经六区活检的研究进行荟萃分析，结果显示，总体敏感性为 54%，特异性为 91%，AUC 为 0.85。与仅使用 T2WI 结果相比，当将弥散加权 MRI 数据与 T2WI 结合使用时，放疗后患者的敏感性显著提高。这种情况在以患者为单位（ = 0.027）或六区活检为单位（ = 0.046）进行荟萃分析时均成立。当将 H 磁共振波谱（H-MRS）数据与 T2WI 结合并以六区活检为分析单位时，也得到了类似的结果（ = 0.036）。
对于接受根治性前列腺切除术的患者，功能 MRI 数据可能无法增强 T2WI 检测局部复发性前列腺癌的能力。相比之下，弥散加权 MRI 和 H-MRS 数据可能会提高 T2WI 对接受放疗患者的敏感性。
