^18F-FDG PET显像用于脑胶质瘤分级的Meta分析

The effciency of ^18F-FDG PET for glioma grading： a Meta-analysis

目的用Meta分析法综合评价18F—FDGPET显像对脑胶质瘤分级的能力。方法搜索Medline、中国期刊网关于”F-FDGPET显像诊断脑胶质瘤的中英文文献。提取文献中用半定量法或目测法判定胶质瘤恶性程度的数据，同时按照Cochrane工作组推荐的诊断评价标准进行文献的质量方法学评估。用Meta分析软件（Meta—Disc）对纳入文献汇总分析，获得汇总灵敏度（Se）和特异性（Sp）及其95％可信区间（a），并绘制汇总受试者工作特征（SROC）曲线，计算曲线下面积（AUC）。结果共获取文献17篇（英文16篇、中文1篇），其中11篇可获取用半定量法[肿瘤／皮质放射性比值（T／C）组及肿瘤／白质放射性比值（T／W）组]判定胶质瘤恶性程度的数据，共272例患者；9篇可获取以目测法判定胶质瘤恶性程度的数据，共481例患者（目测组，部分文献包含2种以上判定方法）。通过异质性检验，分别采用不同效应模型进行分析。T／C组、T／W组和目测组的汇总Se分别为0．952，0．857和0．810；Sp分别为0．409，0．538和0．870；诊断比值（DOR）分别为11．746，22．066和15．282。汇总Se的95％CI分别为0．903—0．980、0．768～0．922和0．757—0．855；汇总Sp的95％凹分别为0．318～0．504，0．431—0．642和0．819～0．911；汇总DOR的95％口分别为5．368—25．702，7．077～68．800和3．716～62．851。3组AUC分别为0．8604，0．8373和0．8724。结论利用18F-FDGPET显像对脑胶质瘤进行恶性程度预测时，半定量组的Se较高，有利于阳性病例的检出，目测组sp较高，有利于阴性病例的排除。根据AUC判断，目测组总体诊断效能最高，T／C组次之，T／W组再次。

Objective To systematically review the efficiency of ^18F-FDG PET in glioma grading by using Meta-analysis. Methods Retrieval in PubMed and China National Knowledge Infrastructure （CNKI） was performed. Relevant papers concerning with glioma diagnoses with ^18F- FDG PET were selected. Paper quality was evaluated according to the standard of diagnostic test recommended by Cochrane Workshop. The data of glioma malignancy degree defined as semi-quantitatively and qualitatively were extracted from the pa- pers. Meta-analysis was conducted with the Meta-Disc software to calculate pooled weighted sensitivity and specificity with 95% confidence interval （CI）. Summary receiver operating characteristic （SROC） curve was performed and the areas under the curve （AUC） were calculated. Results Seven hundred and fifty- three patients from 17 papers （16 in English, 1 in Chinese） were included. Two hundred and seventy-two patients from 11 papers were using semi-quantitative （tumor to cortex ratio, T/C ; tumor to white matter ratio, T/W） method and 481 patients from 9 papers were using qualitative method （visual observation, some of the papers had 2 or more methods）. After heterogeneity test was done, different effect models were selected. The pooled weighted sensitivity, specificity and diagnostic odds ratio （DOR） with 95% CI for T/C group was 0. 952 （ 95 % CI： 0. 903 - 0. 980）, 0. 409 （ 95 % CI： 0.318 - 0. 504 ） and 11. 746 （ 95 % CI： 5. 368-25. 702） respectively. The pooled weighted sensitivity, specificity and DOR with 95% CI for T/W group was 0. 857 （95% CI： O. 768 - 0. 922 ）, 0. 538 （95% CI： 0. 431 - 0. 642） and 22. 066 （ 95% CI： 7. 077-68. 800） respectively. The pooled weighted sensitivity, specificity and diagnostic odds ratio （DOR） with 95% CI for qualitative method was 0. 810 （95% CI： 0. 757-0. 855）, 0. 870 （95% CI： 0. 819- 0.911 ） and 15.282 （95% CI： 3. 716- 62. 851 ） respectively. The AUC for T/C group, T/W group and qualitative method was 0.8604, 0.8373 and 0. 8724 respectively. Conclusions Grading glioma by ,s F-FDG PET with semi-quantitative method may provide high diagnostic sensitivity. If qualitative method is used, the diagnostic specificity may be higher.