磁共振扩散峰度成像对前列腺癌诊断价值的Meta分析

Diagnostic value of magnetic resonance diffusion kurtosis imaging in prostate cancer: Meta-analysis

目的:采用Meta分析综合评价扩散峰度成像(diffusion kurtosis imaging,DKI)对前列腺癌的诊断价值,并定量分析前列腺癌组织与非癌组织的峰度系数(Kapp),为临床决策提供依据。方法:计算机检索PubM ed、EMBASE、EBSCO、Cochrane Library、CNKI、CBM及维普数据库自建库以来至2017年7月31日国内外公开发表的关于DKI应用于前列腺癌诊断的中英文文献。由2名评价员根据纳入与排除标准独立筛选文献、提取资料,并采用QUADAS进行质量评价以及Meta-Disc 1.4和Stata 12.0软件进行Meta分析,提取相关参数。结果:共纳入符合标准文献7篇,患者总例数409例,感兴趣区804个,应用Q检验和I2值进行异质性分析发现文献无异质性,采用固定效应模型分析发现前列腺癌灶组织的Kapp值显著高于非癌组织(P=0.000);合并灵敏度为0.943 [95%CI:0.915～0.962],特异度为0.917 [95%CI:0.829～0.962],阳性似然比为11.365 [95%CI:5.287～24.427],阴性似然比为0.063[95%CI:0.041～0.096],诊断试验比值比(diagnosticoddsratio,DOR)为181.803 [95%CI:65.267～506.419],受试者工作特征曲线的曲线下面积为0.96。结论:DKI对前列腺癌具有较高的诊断价值,且灵敏度、特异度较好。

Objective: To systematically review the diagnostic value of diffusion kurtosis imaging(DKI) in prostate cancer by meta-analysis, and to quantitatively analyze the kurtosis coefficient(Kapp) of prostate cancer tissue and non-cancerous tissue, so as to provide evidence-based basis for clinical decision-making. Methods: The database including PubMed, EMBASE, EBSCO, Cochrane Library, CNKI, CBM, and VIP were electronically searched from inception to July 31, 2017, to collect diagnostic articles about DKI in prostate cancer. Two reviewers independently screened the literatures, extracted data and assessed the methodological quality of included articles by QUADAS tool. Then, the relevant parameters were extracted by applying meta-Disc 1.4 and Stata 12.0 softwares. Results: A total of 7 articles met the inclusion criteria, 409 patients were included, and the number of regions of interest was 804. The fixed effect model was used due to no heterogeneity. The results of Meta-analysis showed that Kapp value in prostate cancer tissue was significantly higher than that in non-cancerous tissue and the pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio(DOR) were 0.943 [95%CI: 0.915-0.962],0.917 [95%CI: 0.829-0.962], 11.365 [95%CI: 5.287-24.427], 0.063 [95%CI: 0.041-0.096], 181.803 [95%CI: 65.267-506.419], respectively, the area under the receiver operating characteristic curve was 0.96. Conclusion: DKI has a high value and good sensitivity and specificity in diagnosis of prostate cancer.