Xuanwu Hospital Capital Medical University, Beijing, China.
Department of General Surgery, Xuanwu Hospital Capital Medical University, Beijing, China
BMJ Open. 2024 Apr 5;14(4):e070364. doi: 10.1136/bmjopen-2022-070364.
To assess and compare the diagnostic value of contrast-enhanced MRI (CEMRI) and contrast-enhanced CT (CECT) for evaluating the response of hepatocellular carcinoma (HCC) after transarterial chemoembolisation (TACE).
Systematic review and meta-analysis.
PubMed, Embase, the Cochrane Library, CNKI and Wanfang databases were systematically searched from inception to 1 August 2023.
Studies with any outcome that demonstrates the diagnostic performance of CEMRI and CECT for HCC after TACE were included.
Two authors independently extracted the data and assessed the quality of included studies. Study quality was assessed using Quality Assessment of Diagnostic Accuracy Studies-2. The diagnostic performance of CEMRI and CECT for the response of HCC was investigated by collecting true and false positives, true and false negatives, or transformed-derived data from each study to calculate specificity and sensitivity. Other outcomes are the positive likelihood ratio/negative likelihood ratio (NLR), the area under the receiver operating characteristic curve (AUC) for diagnostic tests and the diagnostic OR (DOR). Findings were summarised and synthesised qualitatively according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.
This study included 5843 HCC patients diagnosed with CEMRI or CECT and treated with TACE from 36 studies. The mean proportion of men in the total sample was 76.3%. The pool sensitivity, specificity and AUC of CEMRI in diagnosing HCC after TACE were 0.92 (95% CI: 0.86 to 0.96), 0.94 (95% CI: 0.86 to 0.98) and 0.98 (95% CI: 0.96 to 0.99). The pool sensitivity, specificity and AUC of CECT in diagnosing HCC after TACE were 0.74 (95% CI: 0.68 to 0.80), 0.98 (95% CI: 0.93 to 1.00) and 0.90 (95% CI: 0.88 to 0.93).
In conclusion, this study found that both CEMRI and CECT had relatively high predictive power for assessing the response of HCC after TACE. Furthermore, the diagnostic value of CEMRI may be superior to CECT in terms of sensitivity, AUC, DOR and NLR.
评估和比较对比增强磁共振成像（CEMRI）和对比增强 CT（CECT）在评估经动脉化疗栓塞（TACE）后肝细胞癌（HCC）反应中的诊断价值。
系统评价和荟萃分析。
从建库到 2023 年 8 月 1 日，系统地检索了 PubMed、Embase、Cochrane 图书馆、中国知网和万方数据库。
任何能够展示 CEMRI 和 CECT 用于评估 TACE 后 HCC 反应的诊断性能的研究都被纳入。
两位作者独立提取数据并评估纳入研究的质量。使用诊断准确性研究质量评估工具-2 评估研究质量。通过从每项研究中收集真阳性、假阳性、真阴性和假阴性数据来计算特异性和敏感性，以研究 CEMRI 和 CECT 对 HCC 反应的诊断性能。其他结果包括阳性似然比/阴性似然比（NLR）、诊断试验的受试者工作特征曲线下面积（AUC）和诊断优势比（DOR）。根据系统评价和荟萃分析的 Preferred Reporting Items 指南，对结果进行总结和定性综合。
本研究共纳入了 36 项研究中的 5843 例经 CEMRI 或 CECT 诊断并接受 TACE 治疗的 HCC 患者。总样本中男性的平均比例为 76.3%。CEMRI 诊断 TACE 后 HCC 的汇总敏感性、特异性和 AUC 分别为 0.92（95%CI：0.86 至 0.96）、0.94（95%CI：0.86 至 0.98）和 0.98（95%CI：0.96 至 0.99）。CECT 诊断 TACE 后 HCC 的汇总敏感性、特异性和 AUC 分别为 0.74（95%CI：0.68 至 0.80）、0.98（95%CI：0.93 至 1.00）和 0.90（95%CI：0.88 至 0.93）。
总之，本研究发现 CEMRI 和 CECT 对评估 TACE 后 HCC 的反应均具有较高的预测能力。此外，在敏感性、AUC、DOR 和 NLR 方面，CEMRI 的诊断价值可能优于 CECT。
