增强CT和增强MRI诊断肝细胞癌经肝动脉化疗栓塞术后病灶存活或复发价值的Meta分析

Value of contrast-enhanced computed tomography and magnetic resonance imaging in diagnosis of residual or recurrent lesion after transcatheter arterial chemoembolization in hepatocellular carcinoma:A Meta-analysis

目的系统评价增强CT(CECT)和增强磁共振成像(CEMRI)诊断肝细胞癌(HCC)经肝动脉化疗栓塞术(TACE)术后存活或复发病灶的临床价值。方法检索PubMed、Embase、Cochrane Library、Web of Science、CNKI、万方数据库中CECT和(或)CEMRI诊断TACE术后存活或复发HCC病灶的研究,检索时间截止至2019年4月。由2位研究人员独立筛选文献、提取资料后,根据QUADAS-2标准评价纳入研究的偏倚风险后,采用Stata12.0和Revman5.3软件汇总分析敏感度、特异度、受试者工作特征曲线下面积(AUC)。结果共纳入13篇CECT及13篇CEMRI诊断TACE术后存活或复发HCC病灶的研究,分别包括748例患者的934个病灶和557例患者的847个病灶。CECT诊断TACE术后存活或复发HCC病灶的13项研究中存在高度异质性(P=0.001,Q=12.56,I2=84.08%);CEMRI诊断TACE术后存活或复发HCC病灶的13项研究中不存在明显异质性(P=0.473,Q=0.11,I2=0)。CECT诊断TACE术后存活或复发HCC病灶的敏感度、特异度和AUC分别为72%[95%可信区间(95%CI):66%~78%]、99%(95%CI:93%~100%)和0.87(95%CI:0.83~0.89);CEMRI的敏感度、特异度和AUC分别为88%(95%CI:82%~93%)、96%(95%CI:91%~98%)和0.98(95%CI:0.96~0.99)。CECT诊断TACE术后存活或复发病灶的敏感度明显低于CEMRI(Z=2.12,P=0.03)。结论相比于CECT,CEMRI对TACE术后存活或复发病灶具有极高的诊断效能,是诊断TACE术后存活或复发病灶的有效方法。

Objective To systematically evaluate the value of contrast-enhanced computed tomography (CECT) and contrast-enhanced magnetic resonance imaging (CEMRI) in the diagnosis of residual or recurrent lesion after transcatheter arterial chemoembolization (TACE) in hepatocellular carcinoma (HCC).Methods PubMed,Embase,Cochrane Library,Web of Science,CNKI,and Wanfang Data were searched for studies on CECT and/or CEMRI in the diagnosis of residual or recurrent lesion after TACE published up to April 2019.After two reviewers independently performed literature screening,data extraction,and assessment of the risk of bias using the QUADAS-2 tool,Stata 12.0 and RevMan 5.3 were used to analyze pooled sensitivity,specificity,and area under the receiver operator characteristic curve (AUC).Results A total of 13 studies on CECT and 13 studies on CEMRI in the diagnosis of residual or recurrent HCC lesion after TACE were included,with 934 lesions from 748 patients and 847 lesions from 557 patients,respectively.High heterogeneity was observed in the 13 studies on CECT in the diagnosis of residual or recurrent HCC lesion after TACE ( P=0.001,Q=12.56,I 2 =84.08%),while no significant heterogeneity was observed in the 13 studies on CEMRI ( P=0.473,Q=0.11,I 2 =0).In the diagnosis of residual or recurrent HCC lesion after TACE,CECT had a sensitivity of 72%(95% confidence interval [CI]: 66%-78%),a specificity of 99%(95% CI: 93%-100%),and an AUC of 0.87 (95% CI: 0.83-0.89),and CEMRI had a sensitivity of 88%(95% CI: 82%-93%),a specificity of 96%(95% CI: 91%-98%),and an AUC of 0.98 (95% CI: 0.96-0.99).CECT had a significantly lower sensitivity than CEMRI in the diagnosis of residual or recurrent HCC lesion after TACE ( Z=2.12,P= 0.03).Conclusion In comparison with CECT,CEMRI has an extremely higher diagnostic efficiency in the diagnosis of residual or recurrent HCC lesion after TACE and is thus an effective method for diagnosis.