肝脏影像报告和数据系统治疗反应算法的诊断性能：系统评价和荟萃分析。
Diagnostic performance of Liver Imaging Reporting and Data System treatment response algorithm: a systematic review and meta-analysis.
机构信息
Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, South Korea.
Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, South Korea.
出版信息
Eur Radiol. 2021 Jul;31(7):4785-4793. doi: 10.1007/s00330-020-07464-7. Epub 2021 Jan 6.
OBJECTIVE
To systematically determine the accuracy of Liver Imaging Reporting and Data System treatment response (LR-TR) algorithm for diagnosing the viability of hepatocellular carcinoma (HCC) treated with locoregional therapy (LRT).
METHODS
Original studies reporting the diagnostic accuracy of LR-TR algorithm on dynamic contrast-enhanced computed tomography or magnetic resonance imaging (MRI) were identified in MEDLINE and EMBASE up to June 1, 2020. The meta-analytic summary sensitivity and specificity of LR-TR algorithm were calculated using a bivariate random-effects model. Subgroup analyses and meta-regression analysis were performed to explore study heterogeneity.
RESULTS
We found six studies reporting the accuracy of LR-TR viable category (601 observations in 453 patients). The meta-analytic pooled sensitivity and specificity of LR-TR viable category were 63% (95% confidence interval [CI], 39-81%; I = 88%) and 96% (95% CI, 91-99%; I = 76%), respectively. The meta-analytic pooled sensitivity and specificity of LR-TR viable or equivocal category combined were 71% (95% CI, 55-84%; I = 89%) and 87% (95% CI, 73-94% I = 80%), respectively. Studies which used only MRI showed a trend towards higher sensitivity (71% [95% CI, 46-88%]) with a comparable specificity (95% [95% CI, 86-99%]) of LR-TR viable category compared to the whole group. The type of reference standard and study design were significantly associated with study heterogeneity (p ≤ 0.01).
CONCLUSIONS
The LR-TR viable category had high specificity but suboptimal sensitivity for diagnosing the viability of HCC after LRT. Substantial study heterogeneity was noted, and it was significantly associated with the type of reference standard and study design.
KEY POINTS
• The meta-analytic pooled sensitivity and specificity of LR-TR viable category were 63% (95% CI, 39-81%) and 96% (95% CI, 91-99%), respectively. • The meta-analytic pooled sensitivity and specificity of LR-TR viable or equivocal category combined were 71% (95% CI, 55-84%) and 87% (95% CI, 73-94%), respectively. • The type of reference standard and study design were the factors significantly influencing study heterogeneity (p ≤ 0.01).
目的
系统评估肝脏影像报告和数据系统（LR-TR）治疗反应算法在诊断局部区域治疗（LRT）后肝癌（HCC）活力的准确性。
方法
检索 MEDLINE 和 EMBASE 数据库，截至 2020 年 6 月 1 日，查找关于 LR-TR 算法在动态对比增强计算机断层扫描或磁共振成像（MRI）上诊断准确性的原始研究。使用双变量随机效应模型计算 LR-TR 算法的汇总敏感性和特异性。进行亚组分析和荟萃回归分析以探索研究异质性。
结果
我们发现了 6 项研究报告了 LR-TR 有活力类别（453 例患者中的 601 个观察结果）的准确性。LR-TR 有活力类别的荟萃分析汇总敏感性和特异性分别为 63%（95%可信区间，39-81%；I²=88%）和 96%（95%可信区间，91-99%；I²=76%）。LR-TR 有活力或不确定类别的荟萃分析汇总敏感性和特异性分别为 71%（95%可信区间，55-84%；I²=89%）和 87%（95%可信区间，73-94%；I²=80%）。仅使用 MRI 的研究显示出较高的敏感性趋势（71%[95%可信区间，46-88%]），而 LR-TR 有活力类别的特异性相当（95%[95%可信区间，86-99%]）。参考标准的类型和研究设计与研究异质性显著相关（p≤0.01）。
结论
LR-TR 有活力类别在诊断 LRT 后 HCC 活力方面具有较高的特异性，但敏感性不理想。注意到存在大量的研究异质性，并且与参考标准的类型和研究设计显著相关。
关键点
LR-TR 有活力类别的荟萃分析汇总敏感性和特异性分别为 63%（95%可信区间，39-81%）和 96%（95%可信区间，91-99%）。
LR-TR 有活力或不确定类别的荟萃分析汇总敏感性和特异性分别为 71%（95%可信区间，55-84%）和 87%（95%可信区间，73-94%）。
参考标准的类型和研究设计是显著影响研究异质性的因素（p≤0.01）。
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