Department of Radiology, Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam, Gyeonggi, 13620, Republic of Korea.
Neuroradiology. 2021 Apr;63(4):499-509. doi: 10.1007/s00234-020-02538-1. Epub 2020 Aug 31.
Preoperative MRI detection of post-laminar optic nerve invasion (PLONI) offers guidance in assessing the probability of total tumor resection, an estimation of the extent of surgery, and screening of candidates for eye-preserving therapies or neoadjuvant chemotherapies in the patients with retinoblastoma (RB). The purpose of this systematic review and meta-analysis was to evaluate the diagnostic performance of MRI for detecting PLONI in patients with RB and to demonstrate the factors that may influence the diagnostic performance.
Ovid-MEDLINE and EMBASE databases were searched up to January 11, 2020, for studies identifying the diagnostic performance of MRI for detecting PLONI in patients with RB. The pooled sensitivity and specificity of all studies were calculated followed by meta-regression analysis.
Twelve (1240 patients, 1255 enucleated globes) studies were included. The pooled sensitivity was 61%, and the pooled specificity was 88%. Higgins I statistic demonstrated moderate heterogeneity in the sensitivity (I = 72.23%) and specificity (I = 78.11%). Spearman correlation coefficient indicated the presence of a threshold effect. In the meta-regression, higher magnetic field strength (3 T than 1.5 T), performing fat suppression, and thinner slice thickness (< 3 mm) were factors causing heterogeneity and enhancing diagnostic power across the included studies.
MR imaging was demonstrated to have acceptable diagnostic performance in detecting PLONI in patients with RB. The variation in the magnetic field strength and protocols was the main factor behind the heterogeneity across the included studies. Therefore, there is room for developing and optimizing the MR protocols for patients with RB.
术前磁共振成像（MRI）检测视神经后板侵犯（PLONI）有助于评估肿瘤全切的可能性、手术范围的估计，并对视网膜母细胞瘤（RB）患者进行保眼治疗或新辅助化疗的筛选。本系统评价和荟萃分析的目的是评估 MRI 检测 RB 患者 PLONI 的诊断性能，并展示可能影响诊断性能的因素。
截至 2020 年 1 月 11 日，我们在 Ovid-MEDLINE 和 EMBASE 数据库中搜索了识别 MRI 检测 RB 患者 PLONI 的诊断性能的研究。对所有研究的汇总敏感性和特异性进行了计算，随后进行了荟萃回归分析。
共纳入 12 项研究（1240 例患者，1255 例眼球被摘除）。汇总敏感性为 61%，汇总特异性为 88%。Higgins I 统计量显示敏感性（I=72.23%）和特异性（I=78.11%）存在中度异质性。Spearman 相关系数表明存在阈值效应。在荟萃回归中，较高的磁场强度（3T 比 1.5T）、进行脂肪抑制以及较薄的切片厚度（<3mm）是导致异质性和增强纳入研究诊断效能的因素。
MRI 检测 RB 患者 PLONI 的诊断性能良好。磁场强度和方案的变化是纳入研究之间异质性的主要原因。因此，有必要为 RB 患者开发和优化 MRI 方案。
