DWI联合增强MRI对肝硬化背景下小肝癌诊断价值的Meta分析

Diagnostic value of DWI combined enhanced MRI for small hepatocellular carcinoma in patients with cirrhosis: a Meta-analysis

目的应用Meta分析评价磁共振弥散加权成像(DWI)联合增强MRI对肝硬化背景下小肝癌的诊断价值。方法检索PubMed、Web of Science、中国学术期刊网全文数据库、万方数据库、中文科技期刊数据库(VIP),按纳入和排除标准收集2000年1月至2017年12月的文献。采用诊断性试验质量评价表(QUADAS)进行诊断性试验的评价。使用Meta-Disc 1.4及Stata 12.0软件进行统计学分析,采用χ^2检验对各研究的诊断比值比(DOR)进行异质性检验,用I2评估异质性的大小。通过综合受试者工作特征(SROC)曲线及Spearman相关系数检验纳入文献是否存在阈值效应,根据异质性检测结果选择合适的效应模型,通过计算合并灵敏度、特异度、阳性似然比、阴性似然比、DOR、SROC曲线下面积评价DWI联合增强MRI对肝硬化背景下小肝癌的诊断准确率。结果共纳入文献7篇,均为英文文献,包含836例患者,共计1112个病灶。异质性I2=76.6%,这表明纳入的文献有高度异质性,Spearman检验r=-0.14(P= 0.76),这说明不存在由阈值效应导致的异质性。DWI联合增强MRI对肝硬化背景下小肝癌的诊断价值的合并灵敏度、特异度、阳性似然比、阴性似然比、DOR分别为0.90(95%CI:0.88~ 0.92)、0.90(95% CI:0.86~ 0.93)、7.09(95%CI:3.40~ 14.80)、0.13(95% CI:0.08~ 0.21)、64.15(95% CI:24.22~ 169.88)。SROC曲线下面积为0.95。结论DWI联合增强MRI对肝硬化背景下小肝癌的诊断具有较高的灵敏度和特异度,可为肝硬化背景下小肝癌的早期诊断及早期治疗提供重要的依据。

Objective To perform a meta-analysis to evaluate the value of diffusion weighted imaging (DWI) combined with enhanced MRI for the diagnosis of small hepatocellular carcinoma in patients with liver cirrhosis. Methods Articles published over the period of January 2000 to December 2017 were retrieved through the systematic search of PubMed, Web of Science, China National Knowledge Infrastructure, Wanfang, and VIP databases in accordance with inclusion and exclusion criteria. The quality of the included publications was evaluated by using tools for diagnostic accuracy studies. Statistical analysis was performed by using Meta Disc 1.4 and Stata 12.0 software. The heterogeneity of the diagnostic odds ratio(DOR) of each study was tested through the χ^2 test and assessed by using the I2 value. The presence of the threshold effect in each included study was tested by using the summary receiver operating characteristic(SROC) curve and the Spearman correlation coefficient. A suitable effect model for evaluating the accuracy of DWI combined with enhanced MRI for the diagnosis of small hepatocellular carcinoma in patients with liver cirrhosis was selected on the basis of the heterogeneity detection results obtained by calculating pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, DOR, and the area under the SROC. Results Seven studies and 1112 lesions were included in the analysis. The heterogeneity was 76.6%, which indicated that there was a high degree of heterogeneity in the included literature. The Spearman test showed thatr=-0.14(P=0.76), which indicated that there was no heterogeneity caused by threshold effect. Pooled sensitivity and specificity, positive likeliheod ratio, negative likelihood ratio, and DOR were 0.90(95% CI 0.88- 0.92), 0.90(95% CI 0.86- 0.93), 7.09(95% CI 3.40–14.80), 0.13(95% CI 0.08- 0.21), and 64.15(95% CI 24.22–169.88), respectively. The area under the SROC was 0.95. Conclusions DWI combined with enhanced MRI demonstrated high sensitivity and specificity in the diagnosis of small hepatocellular carcinoma in patients with cirrhosis. It can provide important evidence for the early diagnosis and treatment of small hepatocellular carcinoma in patients with cirrhosis.