磁共振灌注成像对胶质瘤良恶性分级的荟萃分析  

Accuracy of MR perfusion weighted imaging for cerebral glioma grading： a meta-analysis

作　　者：闵志刚[1] 刘红娟[2] 李敏[1] 刘丽华[1] 金晨旺[1] 张明[1] 

机构地区：[1]西安交通大学第一附属医院影像中心,710061 [2]西安交通大学第一附属医院影像中心ICU,710061

出　　处：《中华医学杂志》2010年第41期2927-2931,共5页National Medical Journal of China

摘　　要：目的 采用荟萃（Meta）分析方法评价磁共振灌注成像在胶质瘤分级中的价值.方法 检索PUBMED数据库、CNKI（中国知网）系列数据库2009年11月前国内外公开发表的所有中英文文献,要求：（1）采用磁共振灌注成像对胶质瘤良恶性进行分级;（2）以组织病理结果为对照标准.运用双变量随机效应模型和分层综合受试者工作特征曲线模型分析数据,并通过Meta回归方法分析影响诊断准确性的因素.结果 共纳入文献14篇,研究对象共计1021例.汇总敏感度、特异度、诊断比值比及95%可信区间分别为93%（89%～96%）、81%（73%～87%）和55（28～107）.影响诊断准确性的因素有样本量、恶性胶质瘤所占比例、重复时间、造影剂注射速率及所使用的阈值.研究结果间存在异质性.结论 磁共振灌注成像的相对脑血容量值有助于鉴别脑内胶质瘤的良恶性,但目前的研究缺乏统一的阈值,且使用的技术有一定差异,其临床应用价值仍需更多的大样本研究进一步证实.Objective To evaluate values of MR perfusion weighted imaging（PWI）in the grading of intracranial gliomas by a meta-analysis. Methods All English and Chinese literatures published before November 2009 in PUBMED and CNKI（China National Knowledge Infrastructure）were searched.Literature searching requirements：（1）MR PWI with region of interest（ROI）must have been applied in the grading of gliomas;（2）histopathological results must have been used as the reference standards. In addition, after data extraction, a bivariate random-effect model and hierarchical weighted symmetric summary receiver-operating curve must have been utilized to pool the data. Furthermore, a meta regression method must have been applied to detect and analyze the factors that affected the diagnostic accuracy. Results Overall, fourteen studies were included with a total amount of 1021 patients. The pooled sensitivity,specificity and diagnostic odds ratio with 95% of CI were 93%（89%-96%）, 81%（73%-87%）and 55（28-107）, respectively. The factors that affected the diagnostic accuracy were the sample size, the ratio of malignant glioma, the injection rate of contrast agents, the repetition time and the cutoff value.Heterogeneity did exist among the results obtained from different studies. Conclusion the relative cerebral blood volume（rCBV）of MR PWI can be referred to differentiate malignant cerebral gliomas from benign ones with sound sensitivity and specificity. However, there is not a unified threshold applied in the researches that have been conducted so far, and techniques used differ among the studies. In summary,clinical application values of rCBV of MR PWI are to be corroborated by further studies with a larger sample size.

关 键 词：神经胶质瘤 磁共振成像 荟萃分析 

分 类 号：R686[医药卫生—骨科学]