Liu Xiaolong, Liao Keping, Wang Peng, Gao Yongqiang, Du Yongxin
The Affiliated Hospital of Kunming University of Science and Technology, The People's Hospital of Puer, Department of Medical Imaging, Puer, China.
Diagn Interv Radiol. 2025 Sep 8;31(5):423-429. doi: 10.4274/dir.2025.253291. Epub 2025 Jul 21.
Accurate identification of lateral pelvic lymph node (LPLN) metastasis is imperative for guiding LPLN dissection to reduce local recurrence in patients with rectal carcinoma. This meta-analysis aimed to investigate the diagnostic performance of magnetic resonance imaging (MRI) for LPLN metastasis in patients with rectal carcinoma.
Embase, PubMed, Web of Science, and the Cochrane Library were searched to identify studies related to the diagnostic performance of MRI for LPLN metastasis in patients with rectal carcinoma through June 2024.
This meta-analysis included 12 studies comprising 1,015 patients. The pooled sensitivity [95% confidence interval (CI)] and specificity (95% CI) of MRI for diagnosing LPLN metastasis were 0.66 (0.53, 0.80) and 0.82 (0.76, 0.88), respectively. The pooled positive likelihood ratio (LR) (95% CI) and negative LR (95% CI) were 2.82 (2.14, 3.51) and 0.41 (0.27, 0.55), respectively. The summary receiver operating characteristic curve indicated an area under the curve of 0.824. The quality of the included studies was acceptable according to the Quality Assessment of Diagnostic Accuracy Studies-2 tool. However, publication bias was present, as indicated by Deeks' funnel plot asymmetry test ( = 0.020). Considering that heterogeneity contributed to publication bias, a meta-regression analysis was conducted and revealed that heterogeneity could be influenced by sample size, with sample size negatively associated with sensitivity (coefficient: -0.002, = 0.009) and positively associated with negative LR (coefficient: 0.002, = 0.029).
Preoperative MRI demonstrates an acceptable ability to identify LPLN metastasis in patients with rectal carcinoma.
Clinically, our findings support that preoperative MRI has acceptable diagnostic ability for LPLN metastasis in patients with rectal carcinoma. The preoperative application of MRI may aid in optimizing treatment strategies and improving prognosis in this population.
准确识别侧方盆腔淋巴结（LPLN）转移对于指导LPLN清扫以降低直肠癌患者的局部复发至关重要。本荟萃分析旨在研究磁共振成像（MRI）对直肠癌患者LPLN转移的诊断性能。
检索了Embase、PubMed、Web of Science和Cochrane图书馆，以识别截至2024年6月与MRI对直肠癌患者LPLN转移的诊断性能相关的研究。
本荟萃分析纳入了12项研究，共1015例患者。MRI诊断LPLN转移的合并敏感性[95%置信区间（CI）]和特异性（95%CI）分别为0.66（0.53，0.80）和0.82（0.76，0.88）。合并阳性似然比（LR）（95%CI）和阴性LR（95%CI）分别为2.82（2.14，3.51）和0.41（0.27，0.55）。汇总的受试者工作特征曲线显示曲线下面积为0.824。根据诊断准确性研究质量评估-2工具，纳入研究的质量是可接受的。然而，Deeks漏斗图不对称检验表明存在发表偏倚（P = 0.020）。考虑到异质性导致了发表偏倚，进行了荟萃回归分析，结果显示异质性可能受样本量影响，样本量与敏感性呈负相关（系数：-0.002，P = 0.009），与阴性LR呈正相关（系数：0.002，P = 0.029）。
术前MRI在识别直肠癌患者LPLN转移方面具有可接受的能力。
临床上，我们的研究结果支持术前MRI对直肠癌患者LPLN转移具有可接受的诊断能力。术前应用MRI可能有助于优化该人群的治疗策略并改善预后。
