ADC 值鉴别透明细胞肾细胞癌的诊断试验准确性：系统评价和荟萃分析。
Diagnostic test accuracy of ADC values for identification of clear cell renal cell carcinoma: systematic review and meta-analysis.
机构信息
Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, 660 First Avenue, New York, NY, 10016, USA.
Department of Population Health, New York University School of Medicine, New York, NY, 10016, USA.
出版信息
Eur Radiol. 2020 Jul;30(7):4023-4038. doi: 10.1007/s00330-020-06740-w. Epub 2020 Mar 6.
OBJECTIVES
To perform a systematic review on apparent diffusion coefficient (ADC) values of renal tumor subtypes and meta-analysis on the diagnostic performance of ADC for differentiation of localized clear cell renal cell carcinoma (ccRCC) from other renal tumor types.
METHODS
Medline, Embase, and the Cochrane Library databases were searched for studies published until May 1, 2019, that reported ADC values of renal tumors. Methodological quality was evaluated. For the meta-analysis on diagnostic test accuracy of ADC for differentiation of ccRCC from other renal lesions, we applied a bivariate random-effects model and compared two subgroups of ADC measurement with vs. without cystic and necrotic areas.
RESULTS
We included 48 studies (2588 lesions) in the systematic review and 13 studies (1126 lesions) in the meta-analysis. There was no significant difference in ADC of renal parenchyma using b values of 0-800 vs. 0-1000 (p = 0.08). ADC measured on selected portions (sADC) excluding cystic and necrotic areas differed significantly from whole-lesion ADC (wADC) (p = 0.002). Compared to ccRCC, minimal-fat angiomyolipoma, papillary RCC, and chromophobe RCC showed significantly lower sADC while oncocytoma exhibited higher sADC. Summary estimates of sensitivity and specificity to differentiate ccRCC from other tumors were 80% (95% CI, 0.76-0.88) and 78% (95% CI, 0.64-0.89), respectively, for sADC and 77% (95% CI, 0.59-0.90) and 77% (95% CI, 0.69-0.86) for wADC. sADC offered a higher area under the receiver operating characteristic curve than wADC (0.852 vs. 0.785, p = 0.02).
CONCLUSIONS
ADC values of kidney tumors that exclude cystic or necrotic areas more accurately differentiate ccRCC from other renal tumor types than whole-lesion ADC values.
KEY POINTS
• Selective ADC of renal tumors, excluding cystic and necrotic areas, provides better discriminatory ability than whole-lesion ADC to differentiate clear cell RCC from other renal lesions, with area under the receiver operating characteristic curve (AUC) of 0.852 vs. 0.785, respectively (p = 0.02). • Selective ADC of renal masses provides moderate sensitivity and specificity of 80% and 78%, respectively, for differentiation of clear cell renal cell carcinoma (RCC) from papillary RCC, chromophobe RCC, oncocytoma, and minimal-fat angiomyolipoma. • Selective ADC excluding cystic and necrotic areas are preferable to whole-lesion ADC as an additional tool to multiphasic MRI to differentiate clear cell RCC from other renal lesions whether the highest b value is 800 or 1000.
目的
对肾脏肿瘤各亚型表观扩散系数（ADC）值进行系统评价，并对 ADC 鉴别局限性肾透明细胞癌（ccRCC）与其他肾脏肿瘤类型的诊断性能进行 meta 分析。
方法
检索截至 2019 年 5 月 1 日发表的报告肾脏肿瘤 ADC 值的 Medline、Embase 和 Cochrane 图书馆数据库。评估方法学质量。对于 ADC 鉴别 ccRCC 与其他肾脏病变的诊断测试准确性的 meta 分析，我们应用双变量随机效应模型，并比较了有与无囊性和坏死区的两种 ADC 测量亚组。
结果
我们对系统评价纳入了 48 项研究（2588 个病灶），meta 分析纳入了 13 项研究（1126 个病灶）。采用 b 值为 0-800 与 0-1000 时，肾实质 ADC 无显著差异（p=0.08）。与全病灶 ADC（wADC）相比，选择无囊性和坏死区的部分（sADC）测量值差异显著（p=0.002）。与 ccRCC 相比，最小脂肪血管平滑肌脂肪瘤、乳头状 RCC 和嫌色细胞 RCC 的 sADC 明显较低，而嗜酸细胞瘤的 sADC 较高。sADC 鉴别 ccRCC 与其他肿瘤的敏感性和特异性汇总估计值分别为 80%（95%CI，0.76-0.88）和 78%（95%CI，0.64-0.89），wADC 分别为 77%（95%CI，0.59-0.90）和 77%（95%CI，0.69-0.86）。sADC 的受试者工作特征曲线下面积高于 wADC（0.852 与 0.785，p=0.02）。
结论
排除囊性或坏死区的肾脏肿瘤 ADC 值比全病灶 ADC 值更能准确地区分 ccRCC 与其他肾脏肿瘤类型。
关键要点
选择性测量肾肿瘤的 ADC 值，排除囊性和坏死区，与全病灶 ADC 值相比，在鉴别 ccRCC 与其他肾脏病变方面具有更好的鉴别能力，其受试者工作特征曲线下面积（AUC）分别为 0.852 与 0.785（p=0.02）。
选择性测量肾肿块的 ADC 值，对鉴别 ccRCC 与乳头状 RCC、嫌色细胞 RCC、嗜酸细胞瘤和最小脂肪血管平滑肌脂肪瘤的敏感性和特异性分别为 80%和 78%。
排除囊性和坏死区的选择性 ADC 优于全病灶 ADC，可作为多期 MRI 的附加工具，用于鉴别 ccRCC 与其他肾脏病变，无论最高 b 值为 800 还是 1000。
Zotero 插件