磁共振扩散加权成像鉴别诊断胆囊良恶性病变的Meta分析

Diagnostic performance of diffusion weighted imaging for differentiating benign and malignant gallbladder lesions: a Meta-analysis

目的对磁共振扩散加权成像鉴别诊断胆囊良恶性病变的价值进行Meta分析。材料与方法检索自建库起至2018年12月1日PubMed、EMbase、Web of Science、The CochraneLibrary、CNKI、万方数据库、中国生物医学文献数据库、中国科技期刊数据库中有关磁共振扩散加权成像鉴别诊断胆囊良恶性病变的相关文献。2名研究者分别按照所制定的纳入标准以及排除标准独立筛选文献、提取数据并运用QUADAS-2文献质量评价工具及Review Manager 5.3软件评价纳入文献的偏倚风险,采用Stata 12.0软件进行Meta分析。结果最终纳入13篇文献,其中英文8篇,中文5篇,Meta分析结果显示,扩散加权成像(diffusion weighted imaging,DWI)鉴别胆囊良恶性病变的_(合并)敏感度(Sen_(合并))为0.88(95%CI,0.78~0.94)、特异度(Spe_(合并))为0.85(95%CI,0.79~0.89)、阳性似然比(+LR_(合并))为5.84(95%CI,3.97~8.59)、阴性似然比(-LR_(合并))为0.14 (95%CI,0.07~0.28)、诊断比值比(DOR_(合并))为41.88(95%CI,15.42~113.69);汇总受试者工作特征(summary receiver operating characteristic,SROC)曲线下面积为0.93,Q*为0.86。表观扩散系数(apparent diffusion coefficient,ADC)鉴别胆囊良恶性病变的Sen_(合并)为0.79(95%CI,0.71~0.86)、Spe_(合并)为0.93 (95%CI,0.83~0.97)、+LR_(合并)为10.8 (95%CI,4.7~25.1)、-LR_(合并)为0.22 (95%CI,0.16~0.32)、DOR_(合并)为48 (95%CI,18~127);SROC曲线下面积为0.89,Q*为0.82。结论磁共振扩散加权成像对胆囊良恶性病变的鉴别具有较高诊断价值。

Objective: To evaluate the diagnostic value of diffusion weighted magnetic resonance imaging in patients with gallbladder lesions by Meta-analysis. Materials and Methods: Based on validity criteria for diagnostic research published by PubMed, EMbase, Web of Science, The Cochrane Library, CNKI, Wanfang Data, CBM and VIPfrom inception to December 2018, to search the differentiation of gallbladder lesions with diffusion weighted imaging (DWI). Two investigators independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the risk of bias of included studies by using the QUADAS-2 tool and Review Manager 5.3, and then Meta-analysis was conducted using Stata 12.0 software. Results: A total of 13 articles were included (8 English, 5 Chinese). The results of Meta-analysis showed that, the pooled sensitivity (Sen), speci ficity (Spe), positive likelihood ratio (+LR), negative likelihood ratio (-LR), diagnostic odds ratio (DOR) of DWI for differentiating benign and malignant gallbladder lesions were 0.88(95%CI, 0.78 0.94), 0.85(95%CI, 0.79 0.89), 5.84(95%CI, 3.97 8.59), 0.14(95%CI, 0.07 0.28), 41.88 (95%CI, 15.42 113.69), and the area under summary receiver operating characteristic (SROC) curve of DWI for differentiating benign and malignant gallbladder lesions is 0.93, Q*=0.86. The pooled Sen, Spe,+LR,-LR, DOR of apparent diffusion coefficient (ADC) for differentiating benign and malignant gallbladder lesions were 0.79(95%CI, 0.71 0.86), 0.93(95%CI, 0.83 0.97), 10.8(95%CI, 4.7 25.1), 0.22(95%CI, 0.16 0.32), 48(95%CI, 18 127), and the area under SROC curve of ADC for differentiating benign and malignant gallbladder lesions is 0.89, Q*=0.82 respectively. Conclusions: Diffusion weighted magnetic resonance imaging is of great accuracy in differentiating benign and malignant gallbladder lesions.