MR波谱诊断异柠檬酸脱氢酶突变型胶质瘤的临床价值

Clinical value of magnetic resonance spectroscopy in the diagnosis of isocitrate dehydrogenase mutant gliomas

目的:基于循证医学评估MR波谱(RS)在预测胶质瘤异柠檬酸脱氢酶(IDH)突变型的诊断性能。方法:系统检索Ovid-MEDLINE、Web of Knowledge和Google Scholar数据库,获得MRS诊断胶质瘤IDH突变的临床研究文献,时间至2020年1月。采用Stata和Meta-Disc软件评估MRS诊断的敏感性和特异性,绘制受试者工作特征曲线。基于I2进一步评估研究异质性。Deek's漏斗图验证该研究是否存在发表偏倚。结果:最终10篇符合纳入标准,森林图显示MRS精确诊断胶质瘤IDH分类的敏感性和特异性分别为0.89(95%CI为0.7~0.95)和0.84(95%CI为0.66~0.93)。曲线下面积0.93。敏感性和特异性I2均<70%,提示该研究存在一定程度的异质性,回波时间(TE)长短是影响异质性主要因素。漏斗图证实研究中不存在明显发表偏倚(P>0.05)。结论:MRS是唯一能术前通过检测2-羟基戊二酸来预测胶质瘤IDH类型的影像技术,具有很高敏感性和特异性。长TE采集技术可以显著提高预测IDH突变的敏感性和特异性。

Objective To perform a meta-analysis was to estimate the diagnostic performance of magnetic resonance spectroscopy(MRS)in predicating Isocitrate dehydrogenase(IDH)mutant glioma.Methods The Ovid-MEDLINE,Web of Knowledge,and Google Scholar databases were systematically searched to obtain original studies of the molecular classification of brain tumors with an receiver operating characteristic curve of MRS was constructed by meta-analysis tool named Stata and Meta-Disc.Higgins inconsistency index(I-squared,I2)was performed to investigate the potential presence of heterogeneity.Publication bias analysis was conducted by Deeks'funnel plot test.Results Ten articles met all inclusion and selected for data analysis.The pooled sensitivity of 0.89(95%CI:0.79~0.95),and specificity of 0.84(95%CI:0.66~0.93)were reported for prediction of IDH mutation status using MRS in this study.The pooled area under the curve was 0.93.Slight heterogeneity was evaluated by I2 test with the specificity and sensitivity(I2<70%).Deek testing confirmed no significant publication bias in studies(P>0.05).Conclusions MRS is the only imaging technology that can predict the glioma IDH type by detecting 2-Hydroxyglutarate before surgery with high specificity and sensitivity.Long-TE technology may be useful for predicting IDH mutation with high sensitivity and specificity.