目的：用Meta分析方法评价Gd-EOB-DTPA增强MRI在肝细胞癌（HCC）诊断中的价值。方法：检索Pubmed、Ovid、EBSCO、Cochrane图书馆、万方数据库、维普数据库以及中国期刊网（CNKI），纳入以病理结果或临床资料、实验室检查结果、影像学检查结果和随访共同诊断结果为金标准的关于Gd-EOB-DTPA增强MRI诊断HCC的相关文献。按照Cochrane协作网推荐的诊断性试验纳入标准筛选文献，对纳入文献进行质量评价，提取纳入文献的详细资料。采用Meta Disc 1.4软件进行异质性检验及汇总灵敏度、特异度、阳性似然比、阴性似然比、诊断优势比，绘制汇总受试者工作特征曲线（SROC），计算曲线下面积（AUC），以及进行敏感性分析。结果：纳入文献20篇，各研究间无阈值效应，存在异质性，采用随机效应模型汇总分析，汇总灵敏度、特异度、阳性似然比、阴性似然比、诊断优势比及其95%可信区间分别为0.87（95%可信区间0.85~0.89）、0.94（95%可信区间0.92~0.95）、10.69（95%可信区间5.81~19.67）、0.11（95%可信区间0.07~0.19）、111.77（95%可信区间53.71~232.60）。AUC=0.965，Q指数=0.911。敏感性分析示纳入文献的稳定性良好。结论：肝脏特异性对比剂Gd-EOB-DTPA增强MRI是一种切实可行的无创的影像学检查方法，对于诊断HCC，拥有较高的敏感度及特异度，能更准确地诊断HCC，对其治疗提供重要依据。
Abstract
Objective: To systematically assess the diagnostic performance of Gd-EOB-DTPA enhanced MRI for hepatocellular carcinoma(HCC) using a Meta analysis. Methods: The literatures about the Gd-EOB-DTPA enhanced MRI in the diagnosis of HCC taking the pathology or comprehensive results of clinic data, laboraotory examination, imageological examination and follow-up as a gold standard were got by researching the library database of Pubmed, Ovid, EBSCO, Cochrane library, Wanfang database, Weipu database and CNKI. The criteria were established based on validity criteria for diagnostic research published by the cochrane methods. The methodological quality of the included literatures was assessed and data were extracted. Statistical analysis was performed by using the Meta Disc 1.4 software. Heterogeneity of the included literatures was tested, which was used to select proper effect model to calculate the sensitivity, specificity, positive likelihood ratio(PLR), negative likelihood ratio(NLR) and diagnostic odds ratio(DOR). Then, the summary receiver operating characteristic curve(SROC) was got, and the area under curve(AUC) was calculated. Sensitivity analysis was carried on. Results: Totally 20 studies met the inclusion criteria. No significant threshold effect but heterogeneity was found in these studies. Using random effect model for meta-analysis, the sensitivity, specificity, positive likelihood ratio(PLR), negative likelihood ratio(NLR), diagnostic odds ratio(DOR) and their 95%CI were 0.87(95%CI 0.85~0.89), 0.94(95%CI 0.92~0.95), 10.69(95%CI 5.81~19.67), 0.11(95%CI 0.07~0.19) and 111.77(95%CI 53.71~232.60), respectively. AUC was 0.965 and Q index was 0.911. The sensitivity analysis demonstrated that the stability of included literatures was good. Conclusion: Liver-special contrast agent Gd-EOB-DTPA enhanced MRI can be regarded as an effective and feasible method for diagnosis of HCC, with higher sensitivity and specificity, providing important basis for clinic therapy.
关键词
癌 /
肝细胞；三胺五乙酸；Meta分析；磁共振成像
Key words
Carcinoma, hepatocellular /
Pentetic acid /
Meta-analysis /
Magnetic resonance imaging
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