目的:脾病变可能表现出重叠的影像学特征,从囊肿和血管瘤等良性实体到淋巴瘤和血管肉瘤等恶性肿瘤。这项荟萃分析旨在描述区分恶性和良性脾病变的影像学特征。
方法:遵守PRISMA指南,我们搜索了PubMed,Scopus,和WebofScience对鉴别恶性和良性脾病变的影像学特征的研究。我们提取了有关脾病理学和影像学特征的数据,并通过QUADAS-2评估了方法学质量。使用STATA(17.0版,StataCorp,学院站,TX)。
结果:门脉期低增强,低血管增强模式,扩散限制,后期增强不足,比值比大于10,高度表明恶性肿瘤。提示恶性肿瘤的其他特征包括实体形态,淋巴结病,脾周流体的存在,动脉增强不足,超声波的低回声性,脾肿大,和多个病变的存在。相比之下,囊性形态学,高血管冲洗和高血管持续增强模式,晚期超强期,超声波的消声性,门静脉相位过度,定义明确的边界,钙化有利于良性病理。
结论:该研究强调了对比增强和弥散加权成像在鉴别良恶性脾病变中的关键作用,强调门静脉期增强不足和扩散受限等特征在诊断恶性肿瘤中的作用。此外,这项研究强调了超声造影的价值,这允许关键对比增强模式的可视化,而没有电离辐射暴露的风险。
OBJECTIVE: Splenic lesions might exhibit overlapping imaging features, varying from benign entities like cysts and hemangiomas to malignancies such as lymphoma and angiosarcoma. This meta-analysis aims to delineate imaging characteristics that distinguish malignant from benign splenic lesions.
METHODS: Adhering to PRISMA guidelines, we searched PubMed, Scopus, and Web of Science for studies on imaging features differentiating malignant from benign splenic lesions. We extracted data on splenic pathology and imaging characteristics and assessed the methodological quality via QUADAS-2. Odds ratio meta-analyses were performed using STATA (Version 17.0, Stata Corp, College Station, TX).
RESULTS: Portal phase hypoenhancement, hypovascular enhancement pattern, diffusion restriction, and late phase hypoenhancement, with odds ratios above 10, highly indicate malignancy. Other features suggestive of malignancy include solid morphology, lymphadenopathy, presence of perisplenic fluid, arterial hypoenhancement, hypoechogenicity on ultrasound, splenomegaly, and presence of multiple lesions. In contrast, cystic morphology, hypervascular-washout and hypervascular-persistent pattern of enhancement, late phase hyperenhancement, anechogenicity on ultrasound, portal phase hyperenhancement, well-defined borders, and calcification are in favour of benign pathology.
CONCLUSIONS: The study underscores the critical role of contrast-enhanced and diffusion-weighted imaging in distinguishing malignant from benign splenic lesions, emphasizing the role of features like portal phase hypoenhancement and restricted diffusion in diagnosing malignancies. Additionally, the study emphasizes the value of contrast-enhanced ultrasound, which allows for the visualization of key contrast-enhancement patterns without the risk of ionizing radiation exposure.