Meta-analysis of Quantitative Diffusion-weighted MR Imaging in Differentiating Benign and Malignant Pancreatic Masses

There have been numerous studies done to explore the diagnostic performance of quanti- tative diffusion-weighted （DW） MR imaging to differentiate between benign and malignant pancre- atic masses. However, the results have been inconsistent. We performed a meta-analysis to investigate whether DW-MR imaging can differentiate between these two diseases. Databases including MEDLINE, EMBASE and Cochrane Library were utilized to find relevant articles published between January 2001 and January 2014. A Stata version 12.0 and a Meta-Disc version 1.4 were used to de- scribe primary results. Twelve studies with 594 patients, which fulfilled the inclusion criteria, were enrolled for the analysis. The pooled sensitivity and specificity of DW imaging was 0.91 （95% CI： 0.84, 0.95） and 0.86 （95% CI： 0.76, 0.93） respectively. The area under the curve of the summary re- ceiver operating characteristic was 0.95 （95% CI： 0.93, 0.96）. The results indicated that DW imaging might be a valuable tool for differentiating benign and malignant pancreatic masses.

Platelet count combined with right liver volume and spleen volume measured by magnetic resonance imaging for identifying cirrhosis and esophageal varices

AIM: To determine whether the combination of platelet count(PLT) with spleen volume parameters and right liver volume(RV) measured by magnetic resonance imaging(MRI) could predict the Child-Pugh class of liver cirrhosis and esophageal varices(EV).METHODS: Two hundred and five cirrhotic patients with hepatitis B and 40 healthy volunteers underwent abdominal triphasic-enhancement MRI and laboratory examination of PLT in 109/L. Cirrhotic patients underwent endoscopy for detecting EV. Spleen maximal width(W), thickness(T) and length(L) in mm together with spleen volume(SV) and RV in mm3 were measured by MRI, and spleen volume index(SI) in mm3 was obtained by W × T × L. SV/PLT, SI/PLT and RV × PLT/SV(RVPS) were calculated and statistically analyzed to assess cirrhosis and EV.RESULTS: SV/PLT(r = 0.676) and SI/PLT(r = 0.707) increased, and PLT(r =-0.626) and RVPS(r =-0.802) decreased with the progress of Child-Pugh class(P < 0.001 for all). All parameters could determine the presence of cirrhosis, distinguish between each class of Child-Pugh class, and identify the presence of EV [the areas under the curve(AUCs) = 0.661-0.973]. A m o n g p a ra m e t e r s, R V P S c o u l d b e s t d e t e r m i n e presence and each class of cirrhosis with AUCs of 0.973 and 0.740-0.853, respectively; and SV/PLT could best identify EV with an AUC of 0.782.CONCLUSION: The combination of PLT with SV and RV could predict Child-Pugh class of liver cirrhosis and identify the presence of esophageal varices.

Albumin and magnetic resonance imaging-liver volume to identify hepatitis B-related cirrhosis and esophageal varices

AIM:To investigate whether liver lobe volume and albumin(ALB) could predict the presence and severity of liver cirrhosis,and esophageal varices.METHODS:Seventy-one cirrhotic patients with hepatitis B and 21 healthy individuals were enrolled in this study.All the participants underwent abdominal enhanced magnetic resonance imaging to measure each liver lobe volume,and biochemical workup for testing ALB and Child-Pugh class.All cirrhotic patients underwent upper gastrointestinal endoscopy to show the presence of cirrhotic esophageal varices.Right liver lobe volume(RV),left medial liver lobe volume(LMV),left lateral liver lobe volume(LLV),and caudate lobe volume(CV) were measured using enhanced magnetic resonance imaging.The ratios of RV to ALB(RV/ALB),LMV to ALB(LMV/ALB),LLV to ALB(LLV/ALB) and CV to ALB(CV/ALB) were calculated.Statistical analyses were performed to determine whether and how the combination of liver lobe volume measured using magnetic resonance imaging and albumin could predict the presence and severity of liver cirrhosis,and the presence of esophageal varices.RESULTS:RV,LMV,LLV and CV decreased(r =-0.51-0.373; all P < 0.05),while RV/ALB increased(r = 0.424; P < 0.05),with the progress of Child-Pugh classof liver cirrhosis.RV,LMV,CV,LLV/ALB and CV/ALB could identify presence of liver cirrhosis; LLV and LMV could distinguish Child-Pugh class A from B; RV,LMV,LLV,CV,RV/ALB and LLV/ALB could distinguish class A from C; RV and LLV/ALB could differentiate B from C; and RV,RV/ALB and CV/ALB could identify presence of esophageal varices(all P < 0.05).Among these parameters,CV/ALB could best identify the presence of liver cirrhosis,with an area under receiver operating characteristic curve(AUC) of 0.860,a sensitivity of 82.0% and a specificity of 83.0%.LLV could best distinguish class A from B,with an AUC of 0.761,a sensitivity of 74.4% and a specificity of 73.1%.RV could best distinguish class A from C,with an AUC of 0.900,a sensitivity of 90.3% and a specificity of 84.5%.LLV/ALB could best distinguish class B from C,with an AUC of 0.900,a sensitivity of 93.8% and a specificity of 81.5%.RV/ALB could best identify esophageal varices,with an AUC of 0.890,a sensitivity of 80.0% and a specificity of 83.5%.CONCLUSION:The combination of liver lobe volume and ALB has potential to identify presence and severity of cirrhosis,and presence of esophageal varices.

Computed tomography fluoroscopy guided percutaneous lung biopsy for ground-glass opacity pulmonary lesions:A meta-analysis

AIM:To obtain the diagnostic performance of percutaneous transthoracic needle biopsy(PTNB) under Computed tomography(CT) fluoroscopy guidance for lung ground-glass opacity(GGO).METHODS:We searched for English- and Chineselanguage studies in Pub Med,EMBASE,EBSCO,OVID,and CNKI(China National Knowledge Infrastructure) database.Data were calculated with Meta-Disc version 1.4 and Rev Man version 5.2 software.From the pooled data,we calculated sensitivity(Sen),specificity(Spe),positive likelihood ratio(+LR),negative likelihood ratio(-LR),and diagnostic odds ratio(DOR).Summary receiver operating characteristic(SROC) curves were constructed and incidence of complications was recorded.RESULTS:Four documents included in this present meta-analysis met the criteria for analysis.The pooled Sen,Spe,+LR,-LR and DOR with 95%CI were 0.91(0.86-0.95),1.0(0.91-1.0),18.64(4.83-71.93),0.11(0.05-0.26) and 153.17(30.78-762.33),respectively.The area under the SROC curve was 0.98.The incidence of pneumothorax and hemoptysis was 17.86%-51.80% and 10.50%-19.40%,respectively.CONCLUSION:CT fluoroscopy-guided PTNB,which has an acceptable incidence of complications,can be used as a primary examination method for lung GGO,with moderate sensitivity and specificity.