Ultrasomics in liver cancer: Developing a radiomics model for differentiating intrahepatic cholangiocarcinoma from hepatocellular carcinoma using contrast-enhanced ultrasound

BACKGROUND Hepatocellular carcinoma(HCC)and intrahepatic cholangiocarcinoma(ICC)represent the predominant histological types of primary liver cancer,comprising over 99%of cases.Given their differing biological behaviors,prognoses,and treatment strategies,accurately differentiating between HCC and ICC is crucial for effective clinical management.Radiomics,an emerging image processing technology,can automatically extract various quantitative image features that may elude the human eye.Reports on the application of ultrasound(US)-based radiomics methods in distinguishing HCC from ICC are limited.METHODS In our retrospective study,we included a total of 280 patients who were diagnosed with ICC(n=140)and HCC(n=140)between 1999 and 2019.These patients were divided into training(n=224)and testing(n=56)groups for analysis.US images and relevant clinical characteristics were collected.We utilized the XGBoost method to extract and select radiomics features and further employed a random forest algorithm to establish ultrasomics models.We compared the diagnostic performances of these ultrasomics models with that of radiologists.RESULTS Four distinct ultrasomics models were constructed,with the number of selected features varying between models:13 features for the US model;15 for the contrast-enhanced ultrasound(CEUS)model;13 for the combined US+CEUS model;and 21 for the US+CEUS+clinical data model.The US+CEUS+clinical data model yielded the highest area under the receiver operating characteristic curve(AUC)among all models,achieving an AUC of 0.973 in the validation cohort and 0.971 in the test cohort.This performance exceeded even the most experienced radiologist(AUC=0.964).The AUC for the US+CEUS model(training cohort AUC=0.964,test cohort AUC=0.955)was significantly higher than that of the US model alone(training cohort AUC=0.822,test cohort AUC=0.816).This finding underscored the significant benefit of incorporating CEUS information in accurately distin-guishing ICC from HCC.CONCLUSION We developed a radiomics diagnostic model based on CEUS images capable of quickly distinguishing HCC from ICC,which outperformed experienced radiologists.

High-frame-rate contrast-enhanced ultrasound findings of liver metastasis of duodenal gastrointestinal stromal tumor:A case report and literature review

BACKGROUND Liver metastasis of duodenal gastrointestinal stromal tumor(GIST)is rare.Most reports mainly focus on its treatment and approaches to surgical resection,while details on its contrast-enhanced ultrasound(CEUS)findings are lacking.The diagnosis and imaging modalities for this condition remain challenging.CASE SUMMARY A 53-year-old Chinese man presented with mild signs and symptoms of the digestive tract.He underwent routine examinations after GIST surgery.Magnetic resonance imaging showed a 2.3 cm hepatic space-occupying lesion.All the laboratory test results were within normal limits.For further diagnostic confirmation,we conducted high frame rate CEUS(H-CEUS)and found a malignant perfusion pattern.Heterogeneous concentric hyper-enhancement,earlier wash-in than the liver parenchyma,and two irregular vessel columns could be observed at the periphery of the lesion during the arterial phase.Ultrasound-guided puncture biopsy was used to confirm the diagnosis of the lesion as liver metastasis of duodenal GIST.Imatinib was prescribed after biopsy,and the patient’s clinical course was monitored.CONCLUSION H-CEUS is useful for detecting microcirculation differences,wash-in patterns,and vascular morphogenesis and diagnosing liver metastasis of duodenal GIST.

Value of contrast-enhanced ultrasound in deep angiomyxoma using a biplane transrectal probe:A case report

BACKGROUND Deep angiomyxoma(DAM)is a very rare tumor type.Magnetic resonance imaging(MRI)is considered the best imaging modality for diagnosing DAM.Computed tomography(CT)is used mainly to assess the invasion range of DAM.The value of ultrasonography in the diagnosis of DAM is still controversial.Through a literature review,we summarized the current state of ultrasonic examination for DAM and reported for the first time the contrast-enhanced ultrasound(CEUS)features of DAM seen using a biplane transrectal probe.CASE SUMMARY A 37-year-old woman presented with a sacrococcygeal mass that had gradually increased in size over the previous 6 mo.MRI and CT examinations failed to allow a definite diagnosis to be made.Transperineal core needle biopsy(CNB)guided by transrectal ultrasound and CEUS was suggested after a multidisciplinary discussion.Grayscale ultrasound of the lesion showed a layered appearance with alternating hyperechoic and hypoechoic patterns.Transrectal CEUS showed a laminated distribution of the contrast agent that was consistent with the layered appearance of the tumor on grayscale ultrasound.We performed transperineal CNB of the enhanced area inside the tumor under transrectal CEUS guidance and finally made a definitive diagnosis of DAM through histopathology.The patient underwent laparoscopic-assisted transabdominal surgery combined with transperineal surgery for large pelvic tumor resection and pelvic floor peritoneal reconstruction.No recurrence or metastasis was found at the ninemonth follow-up.CONCLUSION Transrectal CEUS can show the layered perfusion characteristics of the contrast agent,guiding subsequent transperineal CNB of the enhanced area within the DAM.

Application of Intraoperative Contrast-Enhanced Ultrasound in the Resection of Brain Tumors

Objective:To investigate the value of routine intraoperative ultrasound(IU)and intraoperative contrast-enhanced ultrasound(ICEUS)in the surgical treatment of brain tumors,and to explore the utilization of ICEUS for the removal of the remnants surrounding the resection cavity.Methods:In total,51 patients who underwent operations from 2012 to 2018 due to different tumors in the brain were included in this study.The clinical data were evaluated retrospectively.IU was performed in all patients,among which 28 patients underwent ICEUS.The effects of IU and ICEUS on tumor resection and recurrence were evaluated.

Assessment value of contrast-enhanced ultrasound parameters for the nature of breast tumor and their relationship with the malignant biological behavior of tumor

Objective: To discuss the value of contrast-enhanced ultrasound parameters for assessing the nature of breast tumor and their relationship with the malignant biological behavior of tumor. Methods: A total of 176 patients with breast tumor who received surgical treatment in the hospital between January 2015 and January 2017 were divided into breast adenoma group (n=110) and breast cancer group (n=66) according to pathological results. The differences in breast contrast-enhanced ultrasound parameter levels as well as the expression of proliferation, invasion and autophagy genes in tumor tissues were compared between the two groups of patients. Pearson test was used to evaluate the correlation between contrast-enhanced ultrasound parameters and malignant molecule expression in lesion tissue of patients with breast cancer. Results: PI and AUC levels in breast cancer group were greatly higher than those in breast adenoma group;proliferation genes CXCL1 and Notch1 mRNA expression in tumor tissue were higher than those of breast adenoma group whereas HPK1 mRNA expression was lower than that of breast adenoma group;invasion genes Gab2, NUAK1 and FOXF1 mRNA expression in tumor tissue were higher than those of breast adenoma group whereas NDRG1 mRNA expression was lower than that of breast adenoma group;autophagy genes ATG2B, ATG4D and ATG9B mRNA expression in tumor tissue were lower than those of breast adenoma group. Pearson test showed that the contrast-enhanced ultrasound parameters PI and AUC levels in patients with breast cancer were directly correlated with the expression of proliferation, invasion and autophagy molecules in the lesion tissue. Conclusion: The contrast-enhanced ultrasound parameter levels in patients with breast cancer are different from those in patients with benign tumors, and the specific parameter levels are directly correlated with the tumor malignancy and can be used as the reliable means for early disease screening and malignancy assessment.

Contrast-enhanced ultrasound:Improving the preoperative staging of hepatocellular carcinoma and guiding individual treatment

AIM: To investigate the clinical role of contrast-enhanced ultrasound (CEUS) combined with contrast-enhanced computed tomography (CE-CT) or magnetic resonance imaging to improve the preoperative staging of hepatocellular carcinoma (HCC) and guide surgical decision-making. METHODS: Sixty-nine patients who underwent liver resection for HCC in our center were enrolled prospectively in the study. CEUS and CE-CT/MRI were performed before surgery. Intraoperative ultrasound (IOUS) was carried out after liver mobilization. Lesions depicted by each imaging modality were counted and mapped. To investigate the impact of tumor size on the study, we divided the patients into two groups, the 'Smaller group'(S-group, <= 5 cm in diameter) and the 'Largergroup' (L-group, > 5 cm in diameter). The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of CE-CT/MRI, CEUS, IOUS, CEUS+CE-CT/MRI and the tumor node metastasis staging of tumors were calculated and compared. Changes in the surgical strategy as a result of CEUS and IOUS were analyzed. RESULTS: One hundred and twenty-seven nodules, comprising 94 HCCs confirmed by histopathology and 33 benign lesions confirmed by histopathology and follow-up, were identified in 69 patients. The overall diagnostic sensitivity rates of CE-CT/MRI, CEUS, IOUS and CEUS+ CE-CT/MRI were 78.7%, 89.4%, 89.4% and 89.4%, respectively. There was a significant difference between CEUS + CE-CT/MRI and CE-CT/MRI (P = 0.046). Combining CEUS with CT or MRI increased, the diagnostic specificity compared with CT/MRI, CEUS and IOUS, and this difference was statistically significant (100%, 72.7%, 97.0%, and 69.7%, P = 0.004, P = 0.002, P = 0.002, respectively). The diagnostic accuracy was significantly higher for CEUS + CT/MRI compared with CT/MRI (92.1% vs 77.2%, P = 0.001). The TNM staging of tumors based on CEUS + CE-CT/MRI approximated to the final pathological TNM staging (P = 0.977). There was a significant difference in the accuracy of TNM staging when comparing CEUS + CECT/MRI with CE-CT/MRI (P = 0.002). Before surgery, strategies were changed in 15.9% (11/69) of patients as a result of CEUS. Finally, only 5.7% (4/69) of surgical strategies were changed because of IOUS findings. In the S-group, CEUS revealed 12 false positive lesions, including seven false positive lesions that were diagnosed by preoperative imaging examinations and five by IOUS. In contrast, in the L-group, IUOS revealed eight new malignant lesions; six of these lesions were true HCCs that were also identified by preoperative CEUS. CONCLUSION: CEUS combined with CT or MRI improves the accuracy of preoperative staging for hepatocellular carcinoma and may help to guide individualized treatment for patients with HCC. CEUS may better identify non-malignant lesions in patients with small tumors and discover new malignant lesions in patients with large tumors. (C) 2014 Baishideng Publishing Group Inc. All rights reserved.

Analysis of B-ultrasound and contrast-enhanced ultrasound characteristics of different hepatic neuroendocrine neoplasm

BACKGROUND Hepatic neuroendocrine neoplasm(hNEN) is a highly heterogeneous tumor. The exact identification of the source and malignant degree of hNEN is important.However, there is a lack of information regarding diagnosis of hNEN with imaging. In addition, no studies have compared the imaging between hNEN and hepatocellular carcinoma(HCC) and among different sources and malignant degrees of hNEN.AIM To compare the ultrasound characteristics between hNEN and HCC and among different sources and malignant degrees of hNEN.METHODS A total of 55 patients with hNEN were recruited and defined as the hNEN group.Among them, 35 cases of hNET were defined as the hNET group. Twenty cases of hepatic neuroendocrine carcinoma(hNEC) were defined as the hNEC group.Among the 55 lesions, 29 were transferred from the pancreas, 20 were from the gastrointestinal tract, and six were from other sites. In total, 55 patients with HCC were recruited and defined as the HCC group. The characteristic differences of Bmode ultrasound and contrast-enhanced ultrasound(CEUS) between hNEN and HCC and among different sources and malignant degrees of hNEN were compared.RESULTS In the hNEN group, the proportions of multiple liver lesions, unclear borders,and high echo lesions were higher than those in the HCC group. The proportions of non-uniform echo and peripheral acoustic halo were lower than those in the HCC group(P < 0.05). The washout to iso-enhancement time and washout to hypo-enhancement time were lower than those in the HCC group(P < 0.05). The characteristics of B-ultrasound and CEUS among different sources of hNEN were similar, and the differences were not statistically significant(P > 0.05). B-mode ultrasound characteristics of hNET and hNEC were similar. The proportions of low enhancement at portal venous phase, non-uniform enhancement forms, and combined tumor vasculature in the hNEC group were larger than those in the hNEN group(P < 0.05).CONCLUSION Compared with HCC, hNEN showed multiple intrahepatic lesions, uniform high echo, uniform high enhancement at arterial phase, and rapid washout. Low enhancement at portal venous phase, overall non-uniform enhancement form,and the proportion of combined tumor vasculature in hNEC were larger than those in hNET.

Assessment of hepatic VX_2 tumors with combined percutaneous transhepatic lymphosonography and contrast-enhanced ultrasonographic imaging

AIM： To evaluate the feasibility and efficacy of percutaneous transhepatic lymphosonography （PTL） as a novel method for the detection of tumor lymphangiogenesis in hepatic VX2 of rabbits and to evaluate combined PTL and routine contrast-enhanced ultrasonographic imaging for the diagnosis of liver cancer. METHODS： Ten rabbits with VX2 tumor were included in this study. SonoVue （0.1 mL/kg） was injected into each rabbit via an ear vein for contrast-enhanced ultrasonographic imaging, and 0.5 mL SonoVue was injected into the normal liver parenchyma near the VX2 tumor for PTL. Images and/or movie clips were stored for further analysis. RESULTS： UItrasonographic imaging showed VX2 tumors ranging 5-19 mm in the liver of rabbits. The VX2 tumor was hyperechoic and hypoechoic to liver parenchyma at the early and later phase, respectively. The hepatic lymph vessels were visualized immediately after injection of contrast medium and continuously vi- sualized with SonoVue during PTL. The boundaries of VX2 tumors were hyperechoic to liver parenchyma and the tumors. There was a significant difference in the values for the boundaries of VX2 tumors after injection compared with the liver normal parenchyma and the tumor parenchyma during PTL.CONCLUSION： PTL is a novel method for the detection of tumor lymphangiogenesis in hepatic VX2 of rabbits. Combined PTL and contrast-enhanced ultrasonographic imaging can improve the diagnosis of liver cancer.

超声造影对局灶性睾丸病变诊断价值的meta分析

目的系统评价超声造影(contrast-enhanced ultrasound,CEUS)对局灶性睾丸病变的诊断价值。方法检索PubMed、Embase、Cochrane Library、Web of Science、中国生物医学文献数据库(CBM)、中国知网(CNKI)、万方、维普(VIP)数据库,收集从建库至2023年8月10日发表的关于CEUS诊断局灶性睾丸病变的相关文献,根据纳入和排除标准筛选文献、提取数据,并行文献质量评价,采用RevMan5.4、Meta disc1.4及Stata15.0软件分析CEUS在睾丸肿瘤与肿瘤样病变、肿瘤良恶性两个方面的诊断效能。结果最终纳入13篇文献共712个病灶。Meta分析结果显示,CEUS诊断睾丸肿瘤与肿瘤样病变的合并敏感度、特异度、阳性似然比、阴性似然比分别为0.95(95%CI:0.87~0.98)、0.84(95%CI:0.73~0.91)、5.8(95%CI:3.3~10.2)、0.06(95%CI:0.02~0.17),合并受试者工作特征曲线下面积为0.94(95%CI:0.92~0.96);CEUS诊断睾丸良恶性病变的合并敏感度、特异度、阳性似然比、阴性似然比分别为0.95(95%CI:0.85~0.99)、0.81(95%CI:0.65~0.90)、4.9(95%CI:2.5~9.6)、0.06(95%CI:0.02~0.20),合并受试者工作特征曲线下面积为0.96(95%CI:0.94~0.97)。结论CEUS对局灶性睾丸病变具有较高的诊断价值,能为临床诊疗提供参考。

Correlation of contrast-enhanced ultrasound parameters with oncogene expression and cell proliferation activity in breast cancer

Objective: To study the correlation of contrast-enhanced ultrasound parameters with oncogene expression and cell proliferation activity in breast cancer. Methods: Breast cancer lesions and benign breast lesions surgically removed in Zigong Third People's Hospital between May 2014 and February 2017 were selected, contrast-enhanced ultrasound was done before operation to draw the time-intensity curve and calculate the area under the curve (AUC), and the expression of proliferation molecules and tumor suppressor genes were detected after operation. Results:The contrast-enhanced ultrasound parameter AUC of the breast cancer lesion was greatly higher than that of the benign breast lesion;ECT2, ZKSCAN3, USP39 and EphA2 mRNA expression in breast cancer lesions were obviously higher than those in benign breast lesions whereas HPK1, TCEAL17, CCN5, ATG2B and ATG4D mRNA expression were greatly lower than those in benign breast lesions;ECT2, ZKSCAN3, USP39 and EphA2 mRNA expression in breast cancer lesions with high AUC were greatly higher than those in breast cancer lesions with low AUC whereas HPK1, TCEAL17, CCN5, ATG2B and ATG4D mRNA expression were greatly lower than those in breast cancer lesions with low AUC. Conclusion: The contrast-enhanced ultrasound parameter AUC of breast cancer lesion significantly increases and is closely related to the higher expression of pro-proliferation molecules and the lower expression of tumor suppressor genes.

Arterial-phase contrast-enhanced ultrasonography for evaluating anti-angiogenesis treatment: A pilot study

AIM:To verify whether arterial-phase contrast-enhanced ultrasonography(CEUS) of tumor parenchymal tissue is useful for evaluation of anti-angiogenesis agents.METHODS:Rabbits with liver tumor were subjected to CEUS,and images of the nodular maximal diameter in vascular phase were recorded.Image analysis was performed to plot the time intensity curve(TIC) at the tumor parenchyma,which set the diameter of the region of interest of intensity measurement.The TIC was calculated to obtain the time to peak intensity(TPI) and the magnitude of PI.Rabbits were randomly assigned to a treatment group with sorafenib and a control group.Two weeks later,the same ultrasound examination was repeated followed by pathological testing to assess the effect of sorafenib on the liver tumor.RESULTS:In four rabbits in the treatment group,the rate of change of tumor size was decreased comparedwith that of the control(the rate 2.3 vs 7.9,P = 0.02).The TPI of the treatment group elongated significantly(the rate 3.1 vs 1.1,P = 0.07 for SonoVue,2.0 vs 0.88,P = 0.09 for Sonazoid).The magnitude of PI showed no significant changes.In pathological examination,capillary diameters in the treatment group were significantly smaller than those in the control group(26.4 vs 42.8 μm,P = 0.013).CONCLUSION:Analysis of the TIC in the arterial phase of tumor tissue could evaluate the efficacy of antiangiogenesis drug treatment in liver tumor.

Potential application of ultrasound-guided thermal ablation in rare liver tumors

Background: With the advances of imaging techniques, the detection rate of rare liver tumor is increased. However, the therapeutic strategies of the rare liver tumors remain limited. Methods: We analyzed twelve pathologically confirmed rare liver tumors in 8 patients. All of the patients underwent ultrasound(US) guided biopsy and subsequent thermal ablation. The tumors were ablated according to the preoperative plans and monitored by real-time US. CT/MRI fused with contrast enhanced US(CEUS) or three-dimensional(3 D) US-CEUS images were used to guide and assess the ablation zone more accurately during thermal ablation. The rate of technical efficacy was assessed based on the contrast-enhance CT/MRI(CECT/MRI) results one month after ablation. Local tumor progression(LTP), recurrence and complications were followed up and recorded. Results: Among these twelve nodules, nine were subject to US-guided thermal ablation, whereas the other three inconspicuous nodules were subject to CEUS-guided thermal ablation. Intra-procedure CT/MRI-CEUS or 3 D US-CEUS fusion imaging assessments demonstrated that the ablation zone sufficiently covered the original tumor, and no immediate supplementary ablation was required. Additionally, no major complications were observed during the follow-up period. The postoperative CECT/MRI confirmed that the technique success rate was 100%. Within the surveillance period of 13 months, no LTP or recurrence was noted. Conclusions: US-guided thermal ablation was feasible and safe for rare liver tumors. The use of fusion imaging technique might make US-guided thermal ablation as effective as surgical resection, and this technique might serve as a potential therapeutic modality for rare liver tumors in the future.

超声造影对肝脏肿瘤诊断价值的Meta分析

目的分析超声造影对肝脏肿瘤诊断价值的Meta评分。方法选取我院肝脏肿瘤疾病患者31例进行研究,采用超声造影进行诊断,进行Meta评分。结果 对患者进行阈值效应检验审查,如出现阈值效应现象,其敏感度数值与其阴性、阳性存在联系,此外特异性与阳性存在联系,31例患者中,肝血管瘤占93.54%,肝细胞癌占96.77%,肝转移瘤占96.77%,肝内胆管癌占93.54%,数据显示采用超声造影对患者进行诊断具备较高准确率。结论 采用超声造影进行诊断具备较强的敏感性。

超声造影诊断卵巢肿瘤价值的Meta分析

目的采用Meta分析评价超声造影诊断卵巢肿瘤的价值。方法检索中国期刊全文数据库(CNKI)、万方和维普数据库以及Cochrance Library、Pub Med、OVID、Embase等数据库,按照纳入标准和排除标准,搜索超声造影诊断卵巢肿物的诊断性试验。对入选文献使用QUADAS方法学质量评价并采用Meta-Disc1.4软件进行Meta分析计算。结果最终入选11篇文献,共748例病例,其合并敏感性(Sen)和特异性(Spe)分别为0.90、0.93,SROC曲线下面积(AUC)为96.41%。结论超声造影对卵巢良恶性肿瘤具有较好的诊断和鉴别诊断价值。

TURBT术中超声联合神经刺激仪定位闭孔神经阻滞的Meta分析

目的探讨经尿道膀胱肿瘤切除(TURBT)术中超声引导联合神经刺激仪进行闭孔神经阻滞(ONB)的有效性和安全性。方法系统性检索PubMed、the Cochrane Library、Embase、万方、中国知网和维普数据库,搜集在TURBT中采用超声联合神经刺激仪定位ONB的临床研究,检索时限为建库之初至2020年5月。2位独立研究人员根据标题、摘要和全文筛选符合纳入标准的文献并提取资料。最终纳入5篇随机对照研究,每篇研究分为超声引导组(超声组)和神经刺激仪联合超声引导组(联合组),使用相对危险度(RR)作为效应量,使用Cochrane风险偏倚评估表评估纳入研究的质量,并使用Stata 14.2汇总提取的研究数据。结果联合组和超声组ONB的成功率比较,差异有统计学意义(RR1.17,95%CI1.07~1.27),且研究间无明显异质性(I2=0.0%,P=0.951)。2组一次穿刺成功率(RR1.12,95%CI0.99~1.26)、穿刺次数(WMD0.18,95%CI-0.07~0.43)、操作时间(SMD1.25,95%CI-1.32~3.81)、起效时间(WMD-2.78,95%CI-5.62~0.05)比较,差异无统计学意义(P>0.05)。结论超声引导联合神经刺激仪可明显提高ONB的成功率。

Impact of microbubble enhanced, pulsed, focused ultrasound on tumor circulation of subcutaneous VX2 cancer

Background Intravascular microbubble-enhanced acoustic cavitation is capable of disrupting the vascular walls of capillaries and small vessels. This study was designed to investigate the impact of microbubble-enhanced, pulsed and focused ultrasound （MEUS） on the blood perfusion of subcutaneous VX2 tumors in rabbits. Methods Subcutaneous VX2 cancers in twenty New Zealand rabbits were treated by combining high-pressure amplitude, pulsed and focused therapeutic ultrasound （TUS） and intravenous microbubble injections. The TUS transducer was operated with a peak negative pressure of 4.6 MPa and a duty cycle of 0.41%. Controls were subcutaneous VX2 cancers treated with TUS or microbubbles only. Contrast-enhanced ultrasound （CEUS） and intravenous Evans Blue （EB） perfusion were performed to assess the tumor circulation. The tumor microvascular disruption was assessed by histological examination. Results CEUS showed that the tumor circulation almost vanished after MEUS treatment. The average peak grayscale value （GSV） of tumor CEUS dropped significantly from 84.1±22.4 to 15.8±10.8 in the MEUS-treated tumors but no significant GSV changes were found in tumors in the two control groups. The mean tumor EB content of the MEUS-treated tumors was significantly lower than that of the controls. Histological examination found scattered tumor microvascular disruption with intercellular edema after MEUS treatment. Conclusion The tumor circulation of VX2 cancers can be arrested or significantly reduced by MEUS due to microvascular disruption. Chin M~.cl ,I 2014：127 （14）： 2605-2611

超声造影对肾脏良恶性肿瘤诊断价值的Meta分析

目的系统评价超声造影对肾脏良恶性肿瘤的诊断价值。方法计算机检索PubMed、EMbase、The Cochrane Library(2013年第9期)、CBM、CNKI、WanFang Data和VIP,查找超声造影对肾脏良恶性肿瘤的诊断性试验,检索时限截至2013年9月31日。由2位评价者按照纳入与排除标准独立筛选文献、提取资料并评价质量后,采用Meta-Disc 1.4软件进行Meta分析。结果最终纳入7个研究,共462例患者。ROC曲线平面图提示呈"肩臂状"分布,Spearman相关分析提示存在明显的阈值效应(P=0.008),Meta分析结果显示SROC曲线下面积(AUC)=0.98。结论超声造影对肾脏良恶性肿瘤有较好的诊断及鉴别诊断价值。受纳入研究质量和数量限制,上述结论尚需开展更多高质量研究加以验证。

直肠腔内超声与相控阵线圈磁共振在直肠癌术前局部分期中的Meta分析

目的运用Meta分析比较直肠腔内超声(ERUS)与相控阵线圈磁共振(MRI)对直肠癌术前局部分期的准确率。方法检索PubMed、Cochrane Library、OVID、Web of Science和CNKI电子数据库确定ERUS和相控阵线圈MRI对直肠癌术前局部分期准确率的相关临床随机对照研究,建库时间更新至2019年1月。使用STATA 12.0和RevMan 5.3软件进行Meta分析,使用Bgger's检验方法检测发表偏倚。结果共纳入7项研究,发表年限为2005年～2014年,中国3篇,意大利2篇,土耳其1篇,西班牙1篇,共纳入416例患者。Meta分析结果显示,ERUS与相控阵线圈MRI对直肠癌术前T分期的准确率比较,差异无统计学意义(OR=0.91,95%CI:0.63～1.32,P=0.619)。对于直肠癌术前N分期,相控阵线圈MRI的准确率高于ERUS,差异有统计学意义(OR=0.58,95%CI:0.41～0.82,P=0.002)。Bgger's检验结果提示纳入研究无发表偏倚(Pr>|z|=0.453;P>0.05)。结论通过Meta分析发现在直肠癌术前T分期,ERUS与相控阵线圈MRI的准确率相近,而在直肠癌术前N分期,相控阵线圈MRI相对于ERUS具有更高的准确率。