体素内不相干运动中D值鉴别诊断肝脏病变的Meta分析

Differential Diagnosis of Liver Lesions with D Value of Intravoxel Incoherent Motion:A Meta-analysis

目的采用Meta分析综合评价体素内不相干运动(IVIM)中真实扩散系数(D值)鉴别诊断肝脏良恶性病变的价值。方法计算机检索Pubmed、Embase、Springer、Wiley、CNKI、中国生物医学文献数据库(CBM)、维普网及万方数据库从建库至2018年6月收录的应用IVIM中D值鉴别诊断肝脏良恶性病变的中英文文献。按照纳入与排除标准筛选文献,采用QUADAS-2进行质量评价并提取相关参数。采用Stata14.0和Meta-disc1.4软件进行统计学处理。结果共纳入文献11篇,研究总病灶数1050个。D值鉴别肝脏良恶性病变的汇总敏感度、特异度、阳性似然比、阴性似然比、诊断比值比(DOR)、受试者工作特征(ROC)曲线下面积(AUC)分别为95%(95%CI:92%~97%)、86%(95%CI:80%~90%)、6.8(95%CI:4.6~9.9)、0.05(95%CI:0.03~0.10)、127(95%CI:55~291)、0.96(95%CI:0.94~0.97)。D值提示恶性的肝脏病变验后恶性率为86%,提示良性的肝脏病变验后恶性率为5%。经Meta回归及亚组分析发现纳入研究是否含有囊肿为异质性来源(P=0.02)。Deeks漏斗图显示纳入研究不存在发表偏倚。结论 IVIM中D值对肝脏病变的具有较高的诊断价值。

Objective To evaluate the value of D value in voxel incoherent motion(IVIM)in the differential diagnosis of benign and malignant liver lesions by meta-analysis.Methods Computer search of Pubmed,Embase,Springer,Wiley,CNKI,CBM,VIP and Wanfang database from the database to the application of IV value in the application of IVIM upto June 2018 was done to identify the diagnosis of benign and malignant liver lesions.The literature was screened according to the inclusion and exclusion criteria,and QUADAS-2 was used for quality evaluation and relevant parameters were extracted.Statistical processing was performed using Stata 14.0 and Meta-disc 1.4 software.Results A total of 11 articles were included in the literature,and the total number of lesions was 1,050.The D value was used to identify the combined sensitivity,specificity,positive likelihood ratio,negative likelihood ratio,diagnostic odds ratio,and area under the SROC curve of 95%(95%CI:92%to 97%),86%(95%CI:80%to 90%),6.8(95%CI:4.6 to 9.9),0.05(95%CI:0.03 to 0.10),127(95%CI:55 to 291),0.96(95%)CI:0.94~0.97).The D value indicates that the malignant rate of malignant liver lesions after examination is 86%,suggesting that the benign liver lesions have a malignancy rate of 5%.Meta-regression and subgroup analysis revealed whether the included study contained a cyst as a heterogeneous source(P=0.02).The Deeks funnel plot shows that there is no publication bias in the inclusion study.Conclusion The D value in IVIM has a high diagnostic value for liver lesions.