动态增强MRI及~1H-MRS诊断乳腺癌:Meta分析
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摘要
目的采用Meta分析方法评价动态增强MRI(DCE-MRI)、~1H-MRS及两者联合对乳腺癌的诊断效能。方法于PubMed、Embase、Cochrane Library、CNKI、万方、维普数据库检索DCE-MRI、~1H-MRS及两者联合诊断乳腺癌的相关文献,检索时间自建库至2018年5月。采用Meta-Disc 1.4及STATA 12.0统计分析软件进行Meta分析。结果共纳入14篇文献。DCE-MRI、~1H-MRS及两者联合诊断乳腺癌的敏感度分别为0.93[95%CI(0.90,0.95)]、0.80[95%CI(0.76,0.83))和0.95[95%CI(0.92,0.97)],特异度分别为0.77[95%CI(0.73,0.82)]、0.81[95%CI(0.77,0.85)]和0.83[95%CI(0.77,0.87)],诊断比值比分别为43.69[95%CI(28.38,67.26)]、24.24[95%CI(16.24,36.16))和95.64[95%CI(48.90,187.07)),汇总受试者工作特征曲线AUC分别为0.932 9、0.899 9和0.961 9。结论 DCE-MRI及~1H-MRS均为乳腺癌的有效诊断方法,两者联合应用诊断效果更佳。
Objective To observe the diagnostic value of dynamic contrast-enhanced MRI(DCE-MRI),~1H-MRS and the combination of them for breast cancer using Meta-analysis.Methods Literatures from PubMed,Embase,Cochrane Library,CNKI,Wanfang and VIP databases were searched from establishment to May 2018,for the diagnostic studies about breast cancer by DCE-MRI,~1H-MRS and the combination of these two methods.Meta-Disc 1.4 and STATA 12.0 software were used for Meta-analysis.Results Totally 14 studies were enrolled.The pooled sensitivity of DCE-MRI,~1H-MRS and the combination of these two methods in diagnosing breast cancer was 0.93(95%CI[0.90,0.95]),0.80(95%CI[0.76,0.83])and 0.95(95%CI[0.92,0.97]),the pooled specificity was 0.77(95%CI[0.73,0.82]),0.81(95%CI[0.77,0.85])and 0.83(95%CI [0.77,0.87]),the pooled diagnostic odds ratio was 43.69(95%CI [28.38,67.26]),24.24(95%CI[16.24,36.16])and 95.64(95%CI[48.90,187.07]),the AUC of summary receiver operating characteristic curve was 0.932 9,0.899 9 and 0.961 9,respectively.Conclusion DCE-MRI and ~1H-MRS are both effective diagnostic technique for breast cancer,and the combination of these two methods can provide more preferable diagnostic accuracy than single use of them.
Objective To observe the diagnostic value of dynamic contrast-enhanced MRI(DCE-MRI),~1H-MRS and the combination of them for breast cancer using Meta-analysis.Methods Literatures from PubMed,Embase,Cochrane Library,CNKI,Wanfang and VIP databases were searched from establishment to May 2018,for the diagnostic studies about breast cancer by DCE-MRI,~1H-MRS and the combination of these two methods.Meta-Disc 1.4 and STATA 12.0 software were used for Meta-analysis.Results Totally 14 studies were enrolled.The pooled sensitivity of DCE-MRI,~1H-MRS and the combination of these two methods in diagnosing breast cancer was 0.93(95%CI[0.90,0.95]),0.80(95%CI[0.76,0.83])and 0.95(95%CI[0.92,0.97]),the pooled specificity was 0.77(95%CI[0.73,0.82]),0.81(95%CI[0.77,0.85])and 0.83(95%CI [0.77,0.87]),the pooled diagnostic odds ratio was 43.69(95%CI [28.38,67.26]),24.24(95%CI[16.24,36.16])and 95.64(95%CI[48.90,187.07]),the AUC of summary receiver operating characteristic curve was 0.932 9,0.899 9 and 0.961 9,respectively.Conclusion DCE-MRI and ~1H-MRS are both effective diagnostic technique for breast cancer,and the combination of these two methods can provide more preferable diagnostic accuracy than single use of them.
引文
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[10] Pinker K, Bogner W, Baltzer P, et al. Improved diagnostic accuracy with multiparametric magnetic resonance imaging of the breast using dynamic contrast-enhanced magnetic resonance imaging, diffusion-weighted imaging, and 3-dimensional proton magnetic resonance spectroscopic imaging. Invest Radiol, 2014,49(6):421-430.
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[13] 张显文,李红,李娜.DCE-MRI结合1H-MRS对乳腺良恶性肿瘤的诊断价值.中国妇幼保健,2013,28(20):3355-3358.
[14] 严莉,袁新平,朱莉莉,等.磁共振波谱分析技术在乳腺良恶性病变鉴别诊断中的应用价值.贵州医药,2017,41(9):984-985.
[15] 陈萍,田红岸,何金.动态增强磁共振成像及磁共振质子波谱分析联合诊断在乳腺良恶性肿瘤诊断中的价值.实用临床医药杂志,2017,21(23):126-128.
[16] 杨开颜,蒋涛,翟仁友,等.动态增强磁共振成像与磁共振波谱在鉴别乳腺良恶性肿瘤中的价值比较.实用放射学杂志,2008,24(8):1090-1094.
[17] 周欣,张婷婷,胡国清.联合应用1H-MRS与MR动态增强成像诊断乳腺肿瘤.中国医学影像技术,2012,28(9):1669-1672.
[18] 杜红文,黄小燕,张蕴,等.乳腺病变动态增强MRI与MRS的比较研究.实用放射学杂志,2009,25(2):243-248.
[19] Peters NH, Borel Rinkes IH, Zuithoff NP, et al. Meta-analysis of MR imaging in the diagnosis of breast lesions. Radiology, 2008,246(1):116-124.
[20] Clauser P, Marcon M, Dietzel M, et al. A new method to reduce false positive results in breast MRI by evaluation of multiple spectral regions in proton MR-spectroscopy. Eur J Radiol, 2017,92:51-57.
[21] 赵斌,蔡世峰,于台飞,等.MR氢质子波谱在乳腺肿块应用中的价值及技术干扰因素分析.中华放射学杂志,2006,40(3):281-284.
[22] Katz-Brull R, Lavin PT, Lenkinski RE, et al. Clinical utility of proton magnetic resonance spectroscopy in characterizing breast lesions. J Natl Cancer Inst, 2002,94(16):1197-1203.
[23] Stanwell P, Gluch L, Clark D, et al. Specificity of choline metabolites for in vivo diagnosis of breast cancer using 1H MRS at 1.5 T. Eur Radiol, 2005,15(5):1037-1043.
[24] 吴国昌,李伟,胡茂清,等.1H-MRS在乳腺肿瘤中的应用研究.中国CT和MRI杂志,2012,10(4):47-49.
[25] Jacobs MA, Barker PB, Argani P, et al. Combined dynamic contrast enhanced breast MR and proton spectroscopic imaging: A feasibility study. J Magn Reson Imaging, 2005,21(1):23-28.
[26] 祁永红,唐桂波,杨国财.联合应用MR DCE、DWI与1H-MRS对乳腺肿瘤的诊断价值.临床放射学杂志,2016,35(9):1356-1361.
[2] 陈万青,李贺,孙可欣,等.2014年中国恶性肿瘤发病和死亡分析.中华肿瘤杂志,2018,40(1):5-13.
[3] Lee WS, Lee JE, Kim JH, et al. Analysis of prognostic factors and treatment modality changes in breast cancer: A single institution study in Korea. Yonsei Med J, 2007,48(3):465-473.
[4] Whiting PF, Rutjes AW, Westwood ME, et al. QUADAS-2: A revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med, 2011,155(8):529-536.
[5] Aribal E, Asadov R, Ramazan A, et al. Multiparametric breast MRI with 3T: Effectivity of combination of contrast enhanced MRI, DWI and 1H single voxel spectroscopy in differentiation of breast tumors. Eur J Radiol, 2016,85(5):979-986.
[6] Vassiou K, Tsougos I, Kousi E, et al. Application value of 3T 1H-magnetic resonance spectroscopy in diagnosing breast tumors. Acta Radiol, 2013,54(4):380-388.
[7] Lipnick S, Liu X, Sayre J, et al. Combined DCE-MRI and single-voxel 2D MRS for differentiation between benign and malignant breast lesions. NMR Biomed, 2010,23(8):922-930.
[8] Faeghi F, Baniasadipour B, Jalalshokouhi J. Comparative investigation of single voxel magnetic resonance spectroscopy and dynamic contrast enhancement MR imaging in differentiation of benign and malignant breast lesions in a sample of iranian women. Asian Pac J Cancer Prev, 2015,16(18):8335-8338.
[9] Suppiah S, Rahmat K, Mohd-Shah MN, et al. Improved diagnostic accuracy in differentiating malignant and benign lesions using single-voxel proton MRS of the breast at 3 T MRI. Clin Radiol, 2013,68(9):e502-e510.
[10] Pinker K, Bogner W, Baltzer P, et al. Improved diagnostic accuracy with multiparametric magnetic resonance imaging of the breast using dynamic contrast-enhanced magnetic resonance imaging, diffusion-weighted imaging, and 3-dimensional proton magnetic resonance spectroscopic imaging. Invest Radiol, 2014,49(6):421-430.
[11] Teama AH, Hassanien OA, Hashish AE, et al. The role of conventional and functional MRI in diagnosis of breast masses. Egyptian Journal of Radiology & Nuclear Medicine, 2015,46(4):1215-1230.
[12] 陈林丽,赵建农,郭大静,等.1H-MRS联合DCE-MRI在乳腺癌中的应用价值.中国医学计算机成像杂志,2008,14(2):106-110.
[13] 张显文,李红,李娜.DCE-MRI结合1H-MRS对乳腺良恶性肿瘤的诊断价值.中国妇幼保健,2013,28(20):3355-3358.
[14] 严莉,袁新平,朱莉莉,等.磁共振波谱分析技术在乳腺良恶性病变鉴别诊断中的应用价值.贵州医药,2017,41(9):984-985.
[15] 陈萍,田红岸,何金.动态增强磁共振成像及磁共振质子波谱分析联合诊断在乳腺良恶性肿瘤诊断中的价值.实用临床医药杂志,2017,21(23):126-128.
[16] 杨开颜,蒋涛,翟仁友,等.动态增强磁共振成像与磁共振波谱在鉴别乳腺良恶性肿瘤中的价值比较.实用放射学杂志,2008,24(8):1090-1094.
[17] 周欣,张婷婷,胡国清.联合应用1H-MRS与MR动态增强成像诊断乳腺肿瘤.中国医学影像技术,2012,28(9):1669-1672.
[18] 杜红文,黄小燕,张蕴,等.乳腺病变动态增强MRI与MRS的比较研究.实用放射学杂志,2009,25(2):243-248.
[19] Peters NH, Borel Rinkes IH, Zuithoff NP, et al. Meta-analysis of MR imaging in the diagnosis of breast lesions. Radiology, 2008,246(1):116-124.
[20] Clauser P, Marcon M, Dietzel M, et al. A new method to reduce false positive results in breast MRI by evaluation of multiple spectral regions in proton MR-spectroscopy. Eur J Radiol, 2017,92:51-57.
[21] 赵斌,蔡世峰,于台飞,等.MR氢质子波谱在乳腺肿块应用中的价值及技术干扰因素分析.中华放射学杂志,2006,40(3):281-284.
[22] Katz-Brull R, Lavin PT, Lenkinski RE, et al. Clinical utility of proton magnetic resonance spectroscopy in characterizing breast lesions. J Natl Cancer Inst, 2002,94(16):1197-1203.
[23] Stanwell P, Gluch L, Clark D, et al. Specificity of choline metabolites for in vivo diagnosis of breast cancer using 1H MRS at 1.5 T. Eur Radiol, 2005,15(5):1037-1043.
[24] 吴国昌,李伟,胡茂清,等.1H-MRS在乳腺肿瘤中的应用研究.中国CT和MRI杂志,2012,10(4):47-49.
[25] Jacobs MA, Barker PB, Argani P, et al. Combined dynamic contrast enhanced breast MR and proton spectroscopic imaging: A feasibility study. J Magn Reson Imaging, 2005,21(1):23-28.
[26] 祁永红,唐桂波,杨国财.联合应用MR DCE、DWI与1H-MRS对乳腺肿瘤的诊断价值.临床放射学杂志,2016,35(9):1356-1361.