Diagnostic performance of diffusion-weighted magnetic resonance imaging in pulmonary malignant lesions: a meta-analysis.

BACKGROUND

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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.