Muhib Muhammad, Abidi Syeda Labiba Fatima, Ahmed Uzair, Afzal Ahson, Farooqui Anoosh, Khalid Jamil Omer Bin, Ahmed Shayan, Agha Hifza
United Medical & Dental College, Karachi, Sindh, Pakistan.
Dow University of Health Sciences, Karachi, Sindh, Pakistan.
SAGE Open Med. 2024 Nov 8;12:20503121241293496. doi: 10.1177/20503121241293496. eCollection 2024.
Lipomas and atypical lipomatous tumors or well-differentiated liposarcomas (ALTs/WDLs), pose a diagnostic challenge due to their overlapping clinical and imaging features. Accurate differentiation is crucial as treatment strategies differ significantly between benign lipomas and malignant ALTs/WDLs. In recent years, medical imaging techniques have shown promise in distinguishing lipomas from ALTs/WDLs by providing enhanced visualization and assessment of various imaging parameters.
This systematic review aimed to investigate the use of magnetic resonance (MR) imaging and computed tomography (CT) scan to differentiate lipomas from ALTs/WDLs.
A systematic review was conducted by using MEDLINE, PubMed, PubMed Central, Cochrane Library, Google Scholar, and clinical trail.gov to identify imaging studies published between 2001 and 2022. Two independent reviewers reviewed 221 record to scrutinize the studies. The methodological quality of each included studies was assessed the using Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool.
Thirteen retrospective cohort studies included 1,390 of total patients. Among them, 11 studies used MR imaging, 2 studies used CT scan and MR imaging both to differentiate lipoma from ALTs/WDLs. The significant diagnostic variables identified in the included studies were age, size, texture, mean intensity, contrast enhancement, location, septation, and nodularity. The overall, sensitivity, specificity, and accuracy of the included studies for diagnosis of lesions range from 66% to 100%, 37% to 100%, and 76% to 95%, respectively. The positive and negative predictive values range from 46.9% to 90% and 86% to 100%, respectively.
The most frequent diagnostic features of ALTs/ WDLs include tumors ⩾110 mm in size, often in patients over 60, predominantly in the lower extremities, with an irregular shape, incomplete fat suppression, contrast enhancement, nodularity, septation >2 mm, and predictive markers such as lactate dehydrogenase >220 and a short tau inversion recovery-signal intensity ratio >1.18.
脂肪瘤与非典型脂肪瘤性肿瘤或高分化脂肪肉瘤（ALTs/WDLs）因其临床和影像学特征重叠，给诊断带来挑战。准确区分至关重要，因为良性脂肪瘤和恶性ALTs/WDLs的治疗策略差异显著。近年来，医学成像技术通过增强各种成像参数的可视化和评估，在区分脂肪瘤与ALTs/WDLs方面显示出前景。
本系统评价旨在研究磁共振（MR）成像和计算机断层扫描（CT）在区分脂肪瘤与ALTs/WDLs中的应用。
通过使用MEDLINE、PubMed、PubMed Central、Cochrane图书馆、谷歌学术和clinical trail.gov进行系统评价，以识别2001年至2022年发表的影像学研究。两名独立评审员审查了221条记录以筛选研究。使用诊断准确性研究质量评估2（QUADAS - 2）工具评估每项纳入研究的方法学质量。
13项回顾性队列研究共纳入1390例患者。其中，11项研究使用MR成像，2项研究同时使用CT扫描和MR成像来区分脂肪瘤与ALTs/WDLs。纳入研究中确定的显著诊断变量包括年龄、大小、质地、平均强度、对比增强、位置、分隔和结节性。纳入研究对病变诊断的总体敏感性、特异性和准确性分别为66%至100%、37%至100%和76%至95%。阳性和阴性预测值分别为46.9%至90%和86%至100%。
ALTs/WDLs最常见的诊断特征包括肿瘤大小≥110 mm，常见于60岁以上患者，主要位于下肢，形状不规则，脂肪抑制不完全，有对比增强、结节性、分隔>2 mm，以及乳酸脱氢酶>220和短tau反转恢复信号强度比>1.18等预测指标。
