正电子发射计算机体层成像-CT与MR扩散加权成像对前列腺癌淋巴结分期准确性比较的Meta分析

Meta-analysis of positron emission tomography-CT and diffusion weighted imaging in lymph node staging of prostate cancer patients

目的采用Meta分析法比较PET-CT与DWI对前列腺癌淋巴结分期的诊断价值。方法检索PubMed、EMBASE、Cochrane Library、SCI数据库有关的英文文献，并提取纳入研究的一般特征及诊断信息。统计分析采用Meta Disc1．4软件检验异质性，根据异质性结果选择相应的效应模型，计算汇总敏感度和特异度及其95％可信区间，绘制汇总受试者工作特征（SROC）曲线，通过X2检验比较两种检查方法的敏感度及特异度、Z检验比较曲线下面积评判其诊断效能。结果按照纳人和排除标准共获取文献11篇，其中同一研究群体同时行两种检查的3篇，PET-CT组中以^11C-胆碱为显像剂的有8篇，^18F-氟代胆碱为显像剂的有3篇。PET．CT组诊断前列腺癌淋巴结转移的敏感度、特异度（95％可信区间）及SROC曲线下面积分别为0．64（0．57—0．71）、0．93（0．90—0．96）、0．8795，DWI分别为0．59（0．47—0．70）、0．82（0．70—0．91）、0．7707。PET-CT特异度较DWI高，差异有统计学意义（x2=5．531，P〈0．05）。PET-CT与DWI的敏感度差异无统计学意义（X2=0．528，P〉0．05）。两种检查方法的AUC差异无统计学意义（Z=1．699，P〉0．05）。结论对于前列腺癌患者的淋巴结分期，PET-CT较DWI诊断的敏感度相当，特异度更高，诊断效能更好。

Objective To assess and compare the overall diagnostic value of positron emission tomography（PET）-CT and DWI in lymph node staging in patients with prostate cancer by using Meta-analysis.Methods Relevant English articles published on PubMed, EMBASE, Cochrane Library and SCI database were searched.Subsequently, the characteristics of the included articles were appraised and extracted. Statistical analysis was performed employing Meta Disc version 1.4. Heterogeneity of the included articles was tested, which was used to select proper effect model to calculate the pooled sensitivity and specificity and the corresponding 95% CI, summary receiver operating characteristics（SROC） curve was performed and the area under the curve was calculated. The diagnostic performanceincluding the sensitivity, specificity, and the area under the curve was compared between the two groups via X2 test and Z test respectively.Results Eleven of 182 retrieved articles were included, in which 3 articles used two methods of imaging examination at the same time.In PET-CT group, there were eight articles using llC-Choline as imaging agents, three with ISF-Fluorocholine.The pooled sensitivity and specificity and area under SROC curve for PET-CT were 0.64 （0.57-0.71）,0.93 （0.90-0.96）, and 0.8795 respectively. They were 0.59 （0.47-0.70）,0.82 （0.70-0.91）, and 0.7707 for DWI group.The specificity of PET-CT was significantly higher than that of DWI （X2=5.531, P〈0.05）. No significant differences were found in the sensitivity and AUC between the two groups （X2=0.528, Z=1.699, P〉0.05）. Conclusion For lymph node staging in patients with prostate cancer, PET-CT has an equal sensitivity and a higher specificity, a better diagnostic performance compared with DWI. [Key words] Prostatic neoplasms; Magnetic resonance imaging; Meta analysis