特异性肝胆对比剂钆塞酸二钠对肝转移瘤的诊断价值的Meta分析

Diagnostic Value of Gadoxetic Acid Disodium(Gd-EOB-DTPA) for the Detection of Liver Metastases: A Meta-analysis

目的系统评价特异性肝胆对比剂钆塞酸二钠(Gd-EOB-DTPA)对肝转移瘤的诊断价值。方法计算机检索CNKI、CBM、VIP、Wan Fang Data、Pub Med、The Cochrane Library和EMbase数据库,搜集特异性肝胆对比剂Gd-EOB-DTPA用于肝转移瘤诊断的相关诊断性试验,检索时限均为2011年1月至2014年12月。由两名评价员独立筛选文献、提取资料并采用QUADAS-2工具评价纳入研究的偏倚风险后,采用Stata 12.0软件进行Meta分析。结果共纳入来自7个国家的15个研究,共701名患者2 040个结节。Meta分析结果显示:Gd-EOB-DTPA诊断肝转移瘤的Sen_(合并)=0.92[95%CI(0.89,0.95)],Spe_(_(合并))=0.94[95%CI(0.89,0.97)],+LR_(合并)=14.51[95%CI(8.01,26.28)],–LR_(合并)=0.08[95%CI(0.06,0.12)],DOR_(合并)=177.98[95%CI(89.50,353.94)],SROC曲线下面积(AUC)=0.97[95%CI(0.95,0.98)]。亚组分析结果显示,Gd-EOB-DTPA对直径≥10 mm的结节较≤10 mm的结节具有更好的敏感度[>10 mm的结节:Sen_(合并)=0.97,95%CI(0.94,0.99);≤10 mm的结节:Sen_(合并)=0.75,95%CI(0.65,0.85);P<0.001]。3.0T的MRI较1.5T的MRI对肝转移瘤的诊断具有更好的敏感度[3.0T:Sen_(合并)=0.95,95%CI(0.92,0.97);1.5 T:Sen_(合并)=0.90,95%CI(0.87,0.94),P<0.001]。结论 Gd-EOB-DTPA对肝转移瘤具有明确的诊断效能,尤其对于直径>10 mm的结节或者使用3.0T MRI的病例具有更好的诊断敏感度。受纳入研究数量和质量所限,上述结论尚需开展更多高质量研究予以验证。

Objective To systematically review the diagnostic value of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid （Gd-EOB-DTPA） for liver metastases. Methods We searched databases including CNKI, CBM, VIP, WanFang Data, PubMed, EMbase and The Cochrane Library from January 2011 to December 2014 to collect diagnostic tests about Gd-EOB-DTPA for liver metastases. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies by using the QUADAS-2 （Quality Assessment of Diagnostic Accuracy Studies-2） tool. Then, meta-analysis was performed by using Stata 12.0 software. Results A total of 15 studies from seven countries were included, involving 2 040 nodules from 701 patients. The results of meta-analysis showed that, the pooled sensitivity （Sen）, specificity （Spe）, positive likelihood ratio （＋LR）, negative likelihood ratio （-LR） and diagnostic odds ratio （DOR） of Gd-EOB-DTPA for liver metastases were 0.92 （95%CI 0.89 to 0.95）, 0.94 （95%CI 0.89 to 0.97）, 14.51 （95%CI 8.01 to 26.28）, 0.08 （95%CI 0.06 to 0.12）, and 177.98 （95%CI 89.50 to 353.94）, respectively. The area under curve （AUC） of SROC was 0.97 （95%CI 0.95 to 0.98）. The results of subgroup analysis showed that Gd-EOB-DTPA had better Sen in nodules 〉10 mm than the nodules 〈10 mm in diameter （〉10 mm： pooled Sen=0.97, 95%CI 0.94 to 0.99; 〈10 mm： pooled Sen=0.75, 95%CI 0.65 to 0.85; P〈0.001）; The 3.0T MR had better Sen in diagnosing liver metastases compared with 1.5T MR （3.0T： pooled Sen=0.95, 95%CI 0.92 to 0.97; 1.5T： pooled Sen=0.90, 95%CI 0.87 to 0.94; P〈0.001）. Conclusion Gd- EOB-DTPA is of value for the detection of liver metastases. In particular, it is of high sensitivity for the detection of nodules larger than 10 mm, and for the cases using 3.0T high-field MR system. Due to limited quantity and quality of theincluded studies, more high-quality studies are required to verify the above conclusion.