磁共振成像对女性盆腔肿块诊断价值的Meta分析

Magnetic Resonance Imaging in Female Pelvic Masses:A Meta-Analysis

目的应用Meta分析探讨磁共振成像(MRI)对女性盆腔肿块的诊断价值。方法计算机检索近20年来PubMed、Cochrane Database Systematic Reviews、EMbase、中国知网(CNKI)检索平台以及万方数据库中MRI对女性盆腔肿块诊断价值的病例对照研究文献。研究者对文献质量进行严格评价和资料提取,提取符合质量标准的文献中的诊断数据用Metadisc 1.40软件进行Meta分析,以术后病理诊断为金标准,分别合并MRI及B超诊断女性盆腔肿块的灵敏度、特异度、阴性似然比和阳性似然比,采用拟合受试者工作特征曲线(SROC)分析两者的诊断价值,并对二者的各项数据进行比较。结果 10个自身病例对照研究共649例患者729个肿块纳入研究。Meta分析结果显示:MRI诊断女性盆腔肿块的汇总敏感度(95%CI)和汇总特异度(95%CI)分别为〔89%(84%～92%),P=0.046 6〕和〔87%(83%～90%),P=0.000 2〕,汇总阳性似然比和汇总阴性似然比分别为6.25(P=0.008 5)和0.14(P=0.029 1),SROC曲线下面积(AUC)为0.941;B超的汇总敏感度(95%CI)和汇总特异度(95%CI)分别为〔87%(82%～91%),P=0.000 0〕和〔73%(69%～77%),P=0.000 0〕,汇总阳性似然比和汇总阴性似然比分别为3.07(P=0.000 0)和0.18(P=0.000 1),SROC曲线下的面积为0.897。MRI的汇总特异度、阳性似然比和SROC曲线下的面积明显高于B超。结论 MRI对女性盆腔肿块诊断的准确性明显优于B超,MRI应成为怀疑存在盆腔肿块女性首选的影像学检查手段。

Objective To evaluate the sensitivity,specificity,and accuracy of magnetic resonance imaging（MRI）in characterizing adnexal masses.Methods The databases such as the Cochrane Library,PubMed,EMbase,CNKI,and WanFang Data were searched on computer from 1991 to 2011.The reviewers screened the trials according to inclusion and exclusion criteria strictly,extracted the data,and assessed the methodology quality.Meta-analysis were performed using the Metadisc 1.40 software.The acquired pooled sensitivity,specificity,and summary receiver operating characteristic curve（SROC）were used to describe the diagnostic value.The pooled likelihood ratios were calculated based on the pooled sensitivity and specificity.Results Ten case-control studies involving 649 women who were suspected to have pelvic masses were included and 729 masses were confirmed by the postoperative histopathology.The pooled statistical results of meta-analysis showed that：the sensitivity and specificity of MRI were 〔89%（84%-92%）,P=0.046 6〕and〔87%（83%-90%）,P=0.000 2〕respectively,the positive and negative likelihood ratios of MRI were 6.25（P=0.008 5）and 0.14（P=0.029 1）respectively,and the area under the SROC curve（AUC）was 0.941.The sensitivity and specificity of ultrasound were〔87%（82%-91%）,P=0.000 0〕and〔73%（69%-77%）,P=0.000 0〕respectively,the positive and negative likelihood ratios of MRI were 3.07（P=0.000 0）and 0.18（P=0.000 1）respectively,and the AUC was 0.897.The specificity and accuracy of MRI in characterizing female pelvic masses were higher than ultrasound obviously.Conclusion According these evidences,the MRI should be recommended to the women who are suspected to have pelvic masses as a preferred.