MRI和CT细胞外容积对肝纤维化分期诊断价值的Meta分析  

The diagnostic value of MRI and CT extracellular volume in the staging of liver fibrosis:A meta-analysis

作　　者：杨品 姜艳丽[1,2] 邹婕 樊凤仙[1,2] 王瑞 张静 YANG Pin;JIANG Yan-li;ZOU Jie(Department of MRI,Lanzhou University Second Hospital,Lanzhou 730000,China)

机构地区：[1]兰州大学第二医院核磁共振科,兰州730030 [2]甘肃省功能及分子影像临床医学研究中心,兰州730030

出　　处：《放射学实践》2023年第6期731-737,共7页Radiologic Practice

基　　金：兰州大学第二医院“萃英科技创新”计划(CY2021-QN-B09);甘肃省科技计划项目(21JR11RA122);甘肃省功能及分子影像临床医学研究中心(21JR7RA438)。

摘　　要：目的:评价MR-T 1-mapping成像和CT细胞外容积诊断肝纤维化的价值。方法:计算机检索PubMed、Cochrane library、Web of Science、中国知网、维普数据库和万方医学网,查找有关MR及CT的细胞外容积对肝纤维化的诊断性试验,检索时间截止2022年2月。由2位评价员按照纳入与排除标准独立筛选文献、提取资料和评价纳入研究的方法学质量后,采用Meta-Disc 1.4软件进行Meta分析。结果:最终纳入11篇文献,包括968例患者。以肝切除或组织活检病理、磁共振弹性成像(MRE)为金标准。基于MRI的ECV对明显肝纤维化(≥F2)组合并敏感度、特异度及SROC曲线下面积AUC值分别为0.74、0.83、0.9126,对严重肝纤维化(≥F3)组的敏感度、特异度分别为0.79、0.88,对早期肝硬化(F4)组的敏感度、特异度范围分别为0.85~0.87、0.80~0.87;基于CT碘值的ECV-iodine对≥F2、≥F3、F4组的合并敏感度和特异度分别为0.73和0.72、0.70和0.78、0.80和0.68,SROC曲线下面积分别为0.8023、0.8741、0.7465;基于常规CT绝对值的ECV-HU对≥F2、≥F3、F4组的合并敏感度和特异度分别为0.73和0.68、0.71和0.73、0.70和0.70,SROC曲线下面积分别为0.7612、0.7899、0.7680。结论:基于MRI的ECV诊断肝纤维化分期的准确性优于CT,而CT碘值所得ECV-iodine的诊断准确性优于常规CT值所得ECV-HU。Objective:To evaluate the value of extracellular volume based on MR-T 1 mapping and CT images in the diagnosis of liver fibrosis.Methods:Document retrieval was conducted on PubMed,Cochrane Library,Web of Science,CNKI,VIP database and Wanfang Medical Network to retrieve the diagnostic studies about the extracellular volume of MR and CT in the diagnosis of liver fibrosis,until February 2022.Two reviewers independently screened the literature according to the inclusion and exclusion criteria,extracted data,and evaluated the methodological quality of the included studies.Meta-Disc 1.4 software was used for meta-analysis.Results:A total of eleven studies involving 968 patients met the eligible criteria.The histopathology results(hepatectomy or biopsy)or magnetic resonance elastography(MRE)were considered a gold standard.For MRI-based ECV,the pooled sensitivity(SEN),specificity(SPE),and the area under(AUC)of the summary receiver-operating characteristic curve(SROC)were 0.74,0.83,0.9126 for significant liver fibrosis(≥F2)group,respectively;the SEN and SPE were 0.79 and 0.88 for severe liver fibrosis(≥F3)group,respectively;the SEN and SPE ranged from 0.85~0.87,0.80~0.87 for early liver cirrhosis(F4)group,respectively.For ECV-iodine based on CT iodine value,the pooled SEN and SPE were 0.73 and 0.72,0.70 and 0.78,0.80 and 0.68 for≥F2,≥F3,and F4 groups,respectively;the AUC was 0.8023,0.8741,and 0.7465,respectively.For ECV-HU based on the absolute value of conventional CT,the pooled SEN and SPE were 0.73 and 0.68,0.71 and 0.73,0.70 and 0.70 for≥F2,≥F3,and F4 groups,respectively;the AUC was 0.7612,0.7899,and 0.7680,respectively.Conclusion:The accuracy of ECV based on MRI in diagnosing liver fibrosis staging is better than CT,and the diagnostic accuracy of ECV-iodine based on CT iodine value is superior to that of ECV-HU based on conventional CT value.

关 键 词：细胞外基质 肝 磁共振成像 体层摄影术 X线计算机 

分 类 号：R814.4[医药卫生—影像医学与核医学] R445.2[医药卫生—放射医学] R322.47[医药卫生—临床医学] R329.24