摘要目的 评价MRI T2WI联合DWI在前列腺癌诊断中的应用价值。方法 采用荟萃分析,检索中文数据库中国知网、万方数据,英文数据库PubMed。检索时间为建库至2014年12月。中文检索词为“扩散加权成像”或“弥散加权成像”、“前列腺癌”或“前列腺肿瘤”和“T2加权成像”, 英文文献检索词为“diffusion magnetic resonance or diffusion weighted imaging or DW-MRI or DW magnetic resonance and T2 weighted imaging and prostate cancer or prostate carcinoma”。收集公开发表的关于T2WI联合DWI诊断前列腺癌的中英文文献,由2名研究者按盲法严格按纳入、排除标准进行文献筛选和质量评价。采用Stata 12.0软件进行数据分析,计算效应量、综合受试者工作特征曲线(SROC)AUC。结果 按照检索词共获取文献129篇,符合纳入标准文献13篇,共671例患者。Meta分析显示,文献存在非阈值效应(P＞0.05),异质性检验未发现异质性来源。采用随机效应模型,合并敏感度、特异度、阳性似然比、阴性似然比、诊断优势比分别为0.74(95% CI 0.67~0.80)、0.79(95% CI 0.68~0.87)、3.65(95% CI 247~5.38)、0.34(95% CI 0.27~0.43)、11.63(95% CI 6.97~19.39)。SROC计算AUC=0.82(95% CI 0.78~0.85),Q=0.763。发表偏倚检验提示无发表偏倚(P＞0.05)。结论 T2WI联合DWI诊断前列腺癌的有一定的临床运用价值,且广泛运用;而T2WI联合高b值、超高b值下的DWI诊断前列腺癌诊断效能可能更佳,但仍需大样本、前瞻性研究进一步证实。
Abstract：Objective To explore the diagnostic value of T2-weighted imaging combined with diffusion weighted imaging for prostate cancer through a meta-analysis.Methods Pubmed, China Journal Full-text Database, and Wanfang Digital Periodical Database were searched until December 2014 with the following terms: “扩散加权成像”or“弥散加权成像”,“前列腺癌”or“前列腺肿瘤” and “T2加权成像”in Chinese and "diffusion magnetic resonance or diffusion weighted imaging or DW-MRI or DW magnetic resonance and T2-weighted imaging and prostate cancer or prostate carcinoma" in English about the diagnostic performance of T2-weighted combined with diffusion weighted imaging for prostate cancer. Sensitivities and specificities about studies were determined, positive, negative likelihood ratios, diagnostic odds ratio were calculated, and constructed summary receiver operating characteristic curves.Results According to the key words, 129 articles were selected. Thirteen studies (671 patients) met inclusion criteria. The results of meta-analysis showd that there existed non threshold effect in the literatures. The pooled sensitivity of T2WI combined with DWI was 0.74(95% CI 0.67-0.80), the pooled specificity was 0.79(95% CI 0.68-0.87), the positive likelihood ratio was 3.65(95% CI 247-5.38), the negative likelihood ratio was 0.34(95% CI 0.27-0.43), the diagnostic odds ratio was 11.63(95% CI 6.97-19.39), and the SROC area under the curve was 0.82(95% CI 0.78-0.85), Q=0.763.Conclusions T2WI combined with DWI has the limited clinical significance. However, T2WI combined with DWI under the high b vale and Ultra high b value diagnoses prostate cancer will be the new prospective direction. Large samples and quality prospective studies are still needed to be conducted.
眭未凡,田彤彤,胡晓华,杨国美,吴晶涛. MR T2加权成像联合扩散加权成像诊断前列腺癌的Meta分析[J]. 中华解剖与临床杂志, 2016, 21(4): 320-325.
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2016, Vol. 21 
