比较MRI-DWI单双指数模型术前预测肝细胞癌微血管侵犯的Meta分析

Meta-analysis of comparing MRI-DWI mono-and bi-exponential models for preoperative prediction of microvascular invasion in hepatocellular carcinoma

目的:探讨并比较磁共振单双指数模型参数ADC值、D值、D*值、f值术前定量预测肝细胞癌(HCC)微血管侵犯(MVI)的价值。方法:检索PubMed、Web of science、Embase、Cochrane Library、中国知网及万方数据库中关于扩散加权成像(DWI)单指数模型ADC值及体素内不相干运动(IVIM)双指数模型D值、D*值、f值对HCC-MVI诊断效能的研究,时间从建库至2020年11月20日。由2位研究人员独立筛选文献、提取资料及质量评价。结果:共纳入23篇文献(中文10篇,英文13篇),共3540例HCC(MVI阳性1403例,MVI阴性2137例),不存在发表偏倚(P>0.1)。MVI阳性组与MVI阴性组的ADC值(SMD=-0.70,95%CI:-0.94~-0.47,P<0.00001)、D值(SMD=-1.01,95%CI:-1.22~-0.79,P<0.00001)差异有统计学意义,而D*值(SMD=-0.11,95%CI:-0.31~0.09,P=0.30)、f值(SMD=-0.11,95%CI:-0.31~0.09,P=0.28)的组间差异无统计学意义。ADC值及D值术前定量预测HCC-MVI阳性的合并敏感度分别为0.73和0.83(Z=-1.847,P=0.065),特异度分别为0.68和0.72(Z=-0.141,P=0.888),SROC曲线下面积分别为0.7617和0.8560(Z=-2.456,P=0.014)。亚组分析结果提示文献类型、MVI阳性与阴性比例、样本量可能为异质性来源。结论:HCC-MVI阳性的D值及ADC值明显低于HCC-MVI阴性,D值术前定量预测HCC-MVI阳性的效能明显优于ADC值,具有更高的敏感度及特异度。

Objective:To investigate and compare the diagnostic efficacy of ADC value,D value,D*value,f value of magnetic resonance mono-and bi-exponential models for preoperative quantitative prediction of microvascular invasion in hepatocellular carcinoma(HCCMVI).Methods:The databases of PubMed,Web of science,Embase,Cochrane Library,CNKI and Wanfang were researched from establishment to November 20,2020.To search for the diagnostic studies of HCCMVI by using diffusion weighted imaging(DWI)mono-exponential model ADC value or intravoxel incoherent motion(IVIM)bi-exponential model D value,D*value,and f value.Two researchers independently screened the literature,extracted the data and evaluated the quality.Results:Totally 23 up-to-standard literatures(10 in Chinese and 13 in English)were included,including 3540 HCCs(MVI positive:1403 columns,MVI negative:2137 columns).There was no publication bias in each study(P>0.1).There were statistically significant differences between the groups(MVI positive vs MVI negative)of ADC value(SMD=-0.70,95%CI:-0.94~-0.47,P<0.00001),D value(SMD=-1.01,95%CI:-1.22~-0.79,P<0.00001).While there were no statistically significant differences between the groups of D*value(SMD=-0.11,95%CI:-0.31~0.09,P=0.30),f value(SMD=-0.11,95%CI:-0.31~0.09,P=0.28).The combined sensitivities of ADC value and D value for MVI positivity were 0.73 and 0.83(Z=-1.847,P=0.065),the specificities were 0.68 and 0.72(Z=-0.141,P=0.888),and the areas under the SROC curve were 0.7617 and 0.8560(Z=-2.456,P=0.014).The subgroup analysis identified that the type of literature,the ratio of positive to negative MVI,and sample size might be the source of heterogeneity.Conclusions:The D value and ADC value of positive MVI were significantly lower than that of negative MVI,and the diagnostic efficacy of D value for positive MVI was significantly better than that of ADC value,with higher sensitivity and specificity.