MRI对肝硬化背景下肝细胞癌诊断价值的Meta分析

Diagnostic Value of MRI for Hepatocellular Carcinoma in Cirrhotic Patients-A Meta Analysis

目的 采用Meta分析评价MRI对肝硬化背景下肝细胞癌（HCC）的诊断价值。方法 检索2000年1月至2015年3月Pub-Med、Web of Science、Cochrane Library数据库中的有关文献,按照纳入和排除标准筛选文献,提取纳入研究诊断准确性指标的相关数据。用QUADAS-2量表对纳入文献进行质量评价,利用Meta-Disc 1.4及Stata12.0软件包进行Meta分析,并拟合层次综合受试者工作特征（HSROC）曲线。结果 共纳入文献19篇,总计肝细胞癌1303个。研究间各诊断准确性指标均存在异质性,Meta分析结果显示,合并敏感度为0.82（95%CI：0.75~0.87）,合并特异度为0.87（95%CI：0.76~0.93）,beta=0.53（95%CI：-0.05~1.1）,Z=1.79,P=0.073,Lambda=3.39（95%CI：2.65~4.13）。亚组分析显示病灶〈1cm组及细针穿刺组的合并敏感度较低,分别为0.69（95%CI：0.63~0.75）、0.65（95%CI：0.55~0.75）;而扫描肝特异期的合并敏感度较高,为0.86（95%CI：0.84~0.89）。结论 MRI对肝硬化背景下肝细胞癌有较高的诊断价值。

Objective To perform a meta-analysis of the diagnostic value of MRI for hepatocellular carcinoma （HCC） in patients with liver cirrhosis. Methods A search of the Pub-Med,Web of science,Cochrane Library from January 2000 to March 2015was performed to identify studies about diagnostic accuracies of MRI for HCCs in cirrhotic patients. The pub- lished papers were screened according to the inclusion and exclusion criteria. The quality of the included publications was evaluated by using QUADAS-2 tools. All included data was analyzed using Meta-Disc 1.4 and Stata 12.0 software pack- age. Meta-analysis was conducted by HSROC statistical model. Results A total of 19 studies and 1303 HCCs were included for the analysis . The results were ： the pooled sensitivity and specificity were 0.82 （ 95 % C1：0.75-0.87 ） and 0.87 （95% C1：0.76 - 0.93 ） , beta = 0.53 （ 95% CI ： - 0.05 ~ 1.1 ） , Z = 1.79, P = 0. 073, Lambda = 3.39 （ 95% CI ： 2.65 ~ 4.13 ）. The overall sensitivity was lower for HCCs smaller than 1cm than that for HCCs lcm or larger,and for those in fineneedle biopsy group （0.69,95 % C1：0.63-0.75,0.65, 95 % CI：0.55-0.75 ）. The sensitivity was higher in the group with hepatobiliary phase （0.86,95% C1：0.84 -0.89）. Conclusion MRI has a high diagnostic value in the diagnosis of HCCs on the background of cirrhosis.