超顺磁性氧化铁增强MRI对肝脏局灶性病变检出价值的评价

The Value of SPIO-Enhanced MR Imaging in the Focal Hepatic Lesion Detection: A Systematic Review

目的评价超顺磁性氧化铁(SPIO)增强MRI对肝脏局灶性病变的检出价值.方法计算机检索MEDLINE (1966.1～2004.8)、EMBASE (1984～2004)、Cochrane 图书馆 (2004年第1期)、中国生物医学文献光盘数据库 (1978.1～2004.7)、中文生物医学期刊文献数据库 (1994～2004)、中文科技期刊全文数据库 (1989～2004)、多个医学影像学专业杂志及其互联网文献库、相关医药公司文献库;手检3种本专业杂志及相关文献的参考文献,并结合本科室自己的研究,全面搜集研究SPIO增强MRI对肝脏局灶性病变检出价值的影像诊断试验.按制定的纳入标准,纳入基于病灶-病灶分析的已发表和未发表的研究和观察对象为临床怀疑或其它影像学检查怀疑有肝脏局灶性病变的文献,并对其进行方法学质量评价和系统评价.结果共有10篇文献符合纳入标准,共包括418位病人的1 037个病灶,因所有试验提供的数据均无法提取出完整的敏感度和特异度数据,故不能用Cochrane协作网诊断与筛查小组推荐的SROC曲线法进行定量Meta分析,而只能进行描述性评价.本研究显示SPIO增强MRI对肝脏局灶性病变检测敏感度66%～100%,准确度76%～97%,各研究结果间的差异较大.结论因研究的病例数较少,研究间异质性较大,未能进行Meta分析,故目前尚无确切证据表明SPIO增强MRI对肝脏局灶性病变有较高的诊断准确性.今后进行更多的大样本、盲法观察、纳入不同大小和种类的病灶、有统一的分层标准和统一完善的参考标准的影像诊断试验,是非常必要的.

Objective To evaluate the sensitivity and accuracy of SPIO enhanced MR Imaging in the detection of focal hepatic lesions.Methods We searched MEDLINE (19662004), EMBSAE (19842004), The Cochrane Library (Issue 1, 2004), CBMdisc (Jan.1978Jul. 2004), CMCC (19942004), “Radiology”, “AJR” and “European Radiology” database. Data from pharmaceutical companies and our research were also added. Related journals published from 1985 to 2003 were handsearched. Participants were clinically suspected of focal hepatic lesions. The quality of studies was assessed, and descriptive systematic review was applied to evaluate the detection sensitivity and accuracy of the imaging modality.Results Ten studies (418 patients with 1 037 focal hepatic lesions) were included. Because the data of sensitivity and specificity could not be extracted from any of the 10 included studies, it was impossible to do the meta analysis using SROC curve. The sensitivity of SPIO enhanced MRI ranged from 66% to 100%; accuracy ranged from 76% to 97%.Conclusions At present, there is no evidence to ascertain that SPIO enhanced MRI has a considerably high accuracy in the detection of focal hepatic lesions. More studies with good methodology are needed.