Chang Ning, Wang Xiao-Hui, Cui Long-Biao, Yin Hong, Jiang Tao, Chen Fu-Lin, Liu Li-Peng, Zhang Jian
Department of Pulmonary and Critical Care Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China.
Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China.
Transl Lung Cancer Res. 2019 Dec;8(6):738-747. doi: 10.21037/tlcr.2019.10.08.
Overuse or misuse of positron emission tomography/computed tomography (PET/CT) should be avoided for its ionizing-radiation. Diffusion-weighted magnetic resonance imaging (DW-MRI), characterized by no radiation, may be regarded as an alternative in differentiating pulmonary nodules. We aim to estimate the diagnostic accuracy of DW-MRI in diagnosing of pulmonary lesions.
Relevant studies were searched through PubMed and Embase with no language restriction from inception to March 8, 2019. We selected studies reporting sensitivity and specificity of DW-MRI for differentiating pulmonary nodules. A summary estimates of sensitivity, specificity and area under curve (AUC) of receiver operating characteristic (ROC) of DW-MRI were analyzed with a random effects model.
We included data from 37 studies, which altogether included 2,311 pulmonary lesions. The pooled sensitivity and specificity were 0.86 (95% CI, 0.82-0.89) and 0.79 (95% CI, 0.72-0.85), and AUC was 0.90 (95% CI, 0.87-0.92). Subsequent subgroup analysis showed the higher sensitivity of DW-MRI in pulmonary lesion >2 cm in comparison to lesions ≤2 cm, however, higher specificity was observed in smaller lesions.
Radiation-free DW-MRI showed a favorable balance between sensitivity and specificity in diagnosing pulmonary malignancies especially in lesion size ≤2 cm. Existing evidence indicated that DW-MRI may be considered as an independent substitute in diagnosis of lung lesions, which might help to prevent long-term side-effects from radiographic diagnosing and evaluating procedures.
由于正电子发射断层扫描/计算机断层扫描（PET/CT）存在电离辐射，应避免过度使用或滥用。无辐射的扩散加权磁共振成像（DW-MRI）可被视为鉴别肺结节的一种替代方法。我们旨在评估DW-MRI诊断肺部病变的诊断准确性。
通过PubMed和Embase检索从数据库建立至2019年3月8日的相关研究，无语言限制。我们选择报告DW-MRI鉴别肺结节的敏感性和特异性的研究。采用随机效应模型分析DW-MRI的敏感性、特异性及受试者工作特征曲线（ROC）下面积（AUC）的汇总估计值。
我们纳入了37项研究的数据，共包括2311例肺部病变。合并敏感性和特异性分别为0.86（95%CI，0.82-0.89）和0.79（95%CI，0.72-0.85），AUC为0.90（95%CI，0.87-0.92）。随后的亚组分析显示，与直径≤2 cm的病变相比，DW-MRI对直径>2 cm的肺部病变具有更高的敏感性，然而，较小病变的特异性更高。
无辐射的DW-MRI在诊断肺恶性肿瘤方面，尤其是在病变大小≤2 cm时，敏感性和特异性之间具有良好的平衡。现有证据表明，DW-MRI可被视为诊断肺部病变的独立替代方法，这可能有助于预防影像学诊断和评估程序的长期副作用。
