体素内不相干运动扩散加权成像在前列腺癌鉴别诊断及Gleason分级中应用的Meta分析  被引量:12

Intravoxel incoherent motion diffusion-weighted imaging for assessment of the differential diagnosis and Gleason grade in prostate cancer:a Meta-analysis

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作  者:郭定波 曾国飞[1] 杨华[1] 李雪娇 欧芳元 GUO Dingbo;ZENG Guofei;YANG Hua;LI Xuejiao;OU Fangyuan(Department of Radiology,Chongqing Traditional Chinese Medicine Hospital,Chongqing 400021,China)

机构地区:[1]重庆市中医院放射科,重庆400021

出  处:《磁共振成像》2022年第2期69-74,共6页Chinese Journal of Magnetic Resonance Imaging

基  金:重庆市自然科学基金项目(cstc2020jcyj-msxmX0751);重庆市科卫联合医学科研项目(2019QNXM010)。

摘  要:目的采用Meta分析方法综合探讨体素内不相干运动(intravoxel incoherent motion,IVIM)扩散加权成像(diffusion-weighted imaging,DWI)的各参数,包括表观扩散系数(apparent diffusion coefficients,ADC)、真性扩散系数(true diffusion coefficient,D)、灌注相关假性扩散系数(perfusion-related pseudo-diffusion coefficient,D*)和灌注分数(perfusion fraction,f)在前列腺癌(prostate cancer,PCa)鉴别诊断和Gleason分级中的价值。材料与方法于Embase、PubMed、Medline和Cochrane Library数据库检索自建库至2021年8月应用IVIM DWI对PCa进行鉴别诊断和Gleason分级的相关文献。采用Stata 15.0软件进行Meta分析,连续性变量资料采用加权均数差(weighted mean difference,WMD)及其95%CI作为统计效应量,并绘制森林图。通过亚组分析来讨论研究异质性,并评估发表偏倚。结果共纳入文献13篇,涉及504例患者和821个感兴趣区(regions of interest,ROI)。合并结果显示:与健康外周带组织(peripheral zone,PZ)比较,PCa的ADC、D与f值均明显减低{WMD=-0.82[95%CI(-1.01~-0.64)],Z=8.69,P<0.0001;WMD=-0.54[95%CI(-0.78~-0.29)],Z=4.34,P<0.0001;WMD=-6.91[95%CI(-12.12~-1.70)],Z=2.60,P<0.0001}。与ADC值比较,PCa组织中D值明显减低{WMD=-0.20[95%CI(-0.38~-0.03)],Z=2.26,P=0.02}。与低级别(low-grade,LG)PCa组比较,中/高级别(intermediate/high-grade,HG)PCa组ADC值和D值均明显减低{WMD=-0.24[95%CI(-0.30~-0.19)],Z=8.06,P<0.001;WMD=-0.25[95%CI(-0.33~-0.17)],Z=5.99,P<0.001}。结论IVIM参数适用于PCa的鉴别诊断,D值可能比ADC值在PCa灶上的表征价值更大。另外,ADC值与D值可进一步区分LG和HG前列腺癌。Objective:To explore the value of parameters of intravoxel incoherent motion(IVIM)diffusion-weighted imaging(DWI),including apparent diffusion coefficient(ADC),true diffusion coefficient(D),pseudo-diffusion coefficient(D*)and perfusion fraction(f)in the differential diagnosis and Gleason grade of prostate cancer(PCa).Materials and Methods:A literature search on Embase,Medline,PubMed and Cochrane Library was performed to identify all the relevant studies characterizing differential diagnosis and Gleason grade of PCa by IVIM DWI published until August 2021.Stata 15.0 software was used for statistics analysis,for continuous variables,weighted mean difference(WMD)with corresponding 95%confidence interval(95%CI)was used as the statistical effect size,and forest maps were drawn.In addition,subgroup analysis was conducted to assess for heterogeneity,and risk of bias was assessed by Begg’s test.Results:A total of 13 articles were included,involving 504 patients and 821 ROIs.The pooled results of IVIM parameters for differentiating between PCa and healthy peripheral zone(PZ)showed that ADC,D and f values were significantly lower in regions of PCa compared to those of regions of PZ{WMD=-0.82[95%CI(-1.01--0.64)],Z=8.69,P<0.0001;WMD=-0.54[95%CI(-0.78--0.29)],Z=4.34,P<0.0001;WMD=-6.91[95%CI(-12.12--1.70)],Z=2.60,P<0.0001}.In addition,D was significantly lower than ADC in the regions of PCa{WMD=-0.20[95%CI(-0.38--0.03)],Z=2.26,P=0.02}.Compared with the low-grade(LG)PCa group,the pooled results showed that ADC value and D value in intermediate/high-grade(HG)PCa were significantly decreased{WMD=-0.24[95%CI(-0.30--0.19)],Z=8.06,P<0.001;WMD=-0.25[95%CI(-0.33--0.17)],Z=5.99,P<0.001}.Conclusions:IVIM parameters are suitable for the differential diagnosis of PCa,and the D value may be more valuable than the ADC value in the characterization of PCa lesions.In addition,ADC value and D value can further distinguish LG and HG prostate cancer.

关 键 词:前列腺癌 体素内不相干运动 扩散加权成像 GLEASON分级 鉴别诊断 

分 类 号:R445.2[医药卫生—影像医学与核医学] R737.25[医药卫生—诊断学]

 

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