DWI对肝硬化背景下小肝癌诊断价值的meta分析

Diagnostic Value of Diffusion-Weighted Imaging for Small Hepatocellular Carcinoma in Cirrhotic Patients: A Meta-Analysis

目的评价磁共振弥散加权成像(DWI)在肝硬化背景下对小肝癌的诊断价值。方法在Pub Med、EMBASE、Web of science、The Cochrane Library、中国知网、维普数据、万方数据及中国生物医学文献数据库上,计算机检索1990年5月至2015年5月有关DWI在肝硬化背景下诊断小肝癌的文献,由两位研究者根据纳入与排除标准独立筛选文献、获取资料,采用诊断精确性研究的质量鉴定法(QUADAS-2)进行质量评价以及Meta-Disc 1.4软件进行Meta分析,提取数据合并灵敏度、特异度、阳性似然比、阴性似然比,绘制综合受试者工作特征(summary receiving operating characteristic,SROC)曲线,计算曲线下面积(area under the curve,AUC),并进行亚组分析。结果符合纳入标准的共有5篇文献,纳入研究病人总数359人,病灶数共444个。DWI汇总的灵敏度为0.91(95%CI:0.89-0.93),汇总的特异度为0.91(95%CI:0.87-0.94),汇总的阳性似然比为8.39(95%CI:5.59-1 2.6 1),汇总的阴性似然比0.0 7(95%CI:0.04-0.15),SROC曲线下面积AUC为0.9631(Q*=0.9091)。在亚组分析中,直径≤2cm的小肝癌组合并后的灵敏度为89%,特异度为91%,AUC为0.9565(Q*=0.8995)。结论在常规MRI增强的基础上,应用DWI对肝硬化背景下小肝癌有较高的诊断价值,并且对直径≤2cm的小肝癌也有较好的诊断效能。

Objective To perform a meta-analysis of Diffusion-Weighted Imaging as a diagnostic tool for small hepatocellular carcinoma（HCC） in patients with cirrhosis. Methods A computer-based retrieval system was first used to identify reports on the diagnostic efficacy of Diffusion-Weighted Imaging for small HCC in patients with cirrhosis that were published between May 1990 and May 2015 in the following literature databases, including PubMed, EMBASE, Web of science, The Cochrane Library, China National Knowledge Infrastructure（CNKl）, VIP Journal Integration Platform（VJIp）, Wanfang Chinese Periodical Database, and Chinese Biomedicine Database（CBM）. Two investigators, working independently on specific inclusion and exclusion criteria then selected cases from the relevant based The extracted data was subjected to quality assessment of diagnostic accuracy studies （QUADAS-2）. The MetaDisc version 1.4 software was used to conduct meta-analyses, and subgroup analyses were performed. Results 5 studies were included in this meta-analysis with a total of 359 patients and 444 lesions. Diagnosis of small HCC in patients with cirrhosis By DWI had pooled sensitivity of 0.91 （95%CI：0.89-0.93）, pooled specificity of 0.91 （95%CI：0.87-0.94）, pooled positive likelihood ratios of 8.39 （95%CI：5.59-12.61）, pooled negative likelihood ratios of 0.07 （95%CI：0.04-0.15）, respectively. The area under the curve of the summary receiving operating characteristic （SROC） of DWI was 0.9631 （Q＊=0.9091）. In the subgroup analysis, the sensitivity of less than 2cm for small hepatocellular carcinoma combined was 89%, the specificity was 91%, AUC was 0.9565 （Q＊=0.8995）. Conclusion Combined use of DW1 with conventional MRI could be valuable diagnostic tool for small HCC in cirrhotic patients.Furthermore, DWI could provide additional valuable information for small HCC（ ≤ 2.0cm）.