Yang Dawei, She Hualong, Wang Xiaopei, Yang Zhenghan, Wang Zhenchang
Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
Department of Radiology, Affiliated Hospital of Xiangnan University, Chenzhou, China.
J Magn Reson Imaging. 2020 May;51(5):1581-1593. doi: 10.1002/jmri.26963. Epub 2019 Oct 26.
Accurate preoperative assessment of the pathological grade of hepatocellular carcinoma (HCC) could greatly benefit prognostic predictions.
To assess and compare the diagnostic accuracy of the apparent diffusion coefficient (ADC) and tissue diffusivity (D) for the noninvasive pathological grading of HCC.
Meta-analysis.
PubMed/Medline, EMBASE, the Web of Science, and the Cochrane Library were searched to find related original articles published up to May 30, 2019.
FIELD STRENGTH/SEQUENCE: Diffusion-weighted imaging (DWI) and/or intravoxel incoherent motion (IVIM) were performed with a 1.5T or 3.0T scanner.
The Quality Assessment of Diagnostic Accuracy Studies 2 tool was used to assess the methodologic quality.
The bivariate random-effects model was used to obtain the pooled sensitivity and specificity, and the area under summary receiver operating characteristic curve (AUROC) was obtained. Subgroup analyses were performed.
A total of 16 original articles (1428 HCCs) were included. Most studies had a low to unclear risk of bias and minimal concerns regarding applicability. For the discrimination of well-differentiated HCCs, the pooled sensitivity and specificity of the ADC value were 85% and 92%, respectively. For the discrimination of poorly differentiated HCCs, the pooled sensitivity and specificity of the ADC value and D were 84% and 80%, and 92% and 77%, respectively. The summary AUROC of D (0.94) was significantly higher than that of ADC (0.89) (z = -2.718, P = 0.007). The subgroup analyses identified three covariates including size, number of included lesions in the studies, and blindness to the reference standard as possible sources of heterogeneity.
This meta-analysis showed that the ADC and D values had a high to excellent accuracy for the noninvasive pathological grading of HCCs and that the D value was superior to the ADC value for discriminating poorly differentiated HCCs.
3 Technical Efficacy Stage: 2 J. Magn. Reson. Imaging 2020;51:1581-1593.
准确的术前评估肝细胞癌（HCC）的病理分级对预后预测有很大帮助。
评估并比较表观扩散系数（ADC）和组织扩散率（D）对HCC进行无创病理分级的诊断准确性。
荟萃分析。
检索了PubMed/Medline、EMBASE、科学网和Cochrane图书馆，以查找截至2019年5月30日发表的相关原始文章。
场强/序列：使用1.5T或3.0T扫描仪进行扩散加权成像（DWI）和/或体素内不相干运动（IVIM）。
使用诊断准确性研究质量评估2工具评估方法学质量。
采用双变量随机效应模型获得合并敏感性和特异性，并获得汇总受试者操作特征曲线下面积（AUROC）。进行亚组分析。
共纳入16篇原始文章（1428例HCC）。大多数研究的偏倚风险低至不明确，且对适用性的担忧最小。对于高分化HCC的鉴别，ADC值的合并敏感性和特异性分别为85%和92%。对于低分化HCC的鉴别，ADC值和D的合并敏感性和特异性分别为84%和80%，以及92%和77%。D的汇总AUROC（0.94）显著高于ADC（0.89）（z = -2.718，P = 0.007）。亚组分析确定了三个协变量，包括大小、研究中纳入的病变数量以及对参考标准的盲法，作为可能的异质性来源。
这项荟萃分析表明，ADC和D值对HCC的无创病理分级具有高至优异的准确性，并且在鉴别低分化HCC方面，D值优于ADC值。
3 技术效能阶段：2 《磁共振成像杂志》2020年；51:1581 - 1593。
