背景:前列腺癌(PCa)的局部分期对于治疗计划很重要。使用定性标准的放射科医生解释是可变的,具有高特异性,但灵敏度低。定量方法可能有助于诊断囊外延伸(ECE)。
目的:评估定量MRI标记物检测ECE的性能。
方法:系统评价和荟萃分析。
方法:收集28例前列腺癌根治术组织病理学证实为PCa的4800例患者进行荟萃分析。纳入46项研究的患者进行系统评价。
■扩散加权,T2加权,1.5T或3T的动态对比增强MRI
结果:PubMed,Embase,WebofScience,Scopus,我们搜索了Cochrane数据库,以确定有关诊断测试准确性或任何定量MRI标记与ECE相关性的研究.由两个独立的研究者提取的肿瘤接触长度(TCL)和平均表观扩散系数(ADC-平均值)的结果进行荟萃分析。但不适用于其他定量标记,包括放射组学,因为可用的研究数量较少。
方法:计算TCL和ADC平均值的分层汇总接受者工作特征(HSROC)曲线,但汇总工作点仅为TCL计算。异质性通过荟萃回归进行调查。如果P≤0.05,则结果显着。
结果:在TCL的10毫米阈值下,综合敏感性和特异性分别为0.76[95%置信区间(CI)0.71-0.81]和0.68[95%CI0.63-0.73],分别。在15毫米的阈值,综合敏感性和特异性分别为0.70[95%CI0.53-0.83]和0.74[95%CI0.60-0.84].TCL和ADC-平均值的HSROC曲线下面积分别为0.79和0.78。TCL异质性的重要来源包括MRI相对于活检的时机。
结论:TCL的10mm和15mm阈值均可用于临床。从HSROC曲线的比较来看,ADC均值在更高的灵敏度下可能优于TCL。
方法:3技术效率阶段:2.
Local staging of prostate cancer (PCa) is important for treatment planning. Radiologist interpretation using qualitative criteria is variable with high specificity but low sensitivity. Quantitative methods may be useful in the diagnosis of extracapsular extension (ECE).
To assess the performance of quantitative MRI markers for detecting ECE.
Systematic
review and meta-analysis.
4800 patients from 28 studies with histopathologically confirmed PCa on radical prostatectomy were pooled for meta-analysis. Patients from 46 studies were included for systematic
review.
Diffusion-weighted, T2-weighted, and dynamic contrast-enhanced MRI at 1.5 T or 3 T.
PubMed, Embase, Web of Science, Scopus, and Cochrane databases were searched to identify studies on diagnostic test accuracy or association of any quantitative MRI markers with ECE. Results extracted by two independent reviewers for tumor contact length (TCL) and mean apparent diffusion coefficient (ADC-mean) were pooled for meta-analysis, but not for other quantitative markers including radiomics due to low number of studies available.
Hierarchical summary receiver operating characteristic (HSROC) curves were computed for both TCL and ADC-mean, but summary operating points were computed for TCL only. Heterogeneity was investigated by meta-regression. Results were significant if P ≤ 0.05.
At the 10 mm threshold for TCL, summary sensitivity and specificity were 0.76 [95% confidence interval (CI) 0.71-0.81] and 0.68 [95% CI 0.63-0.73], respectively. At the 15 mm threshold, summary sensitivity and specificity were 0.70 [95% CI 0.53-0.83] and 0.74 [95% CI 0.60-0.84] respectively. The area under the HSROC curves for TCL and ADC-mean were 0.79 and 0.78, respectively. Significant sources of heterogeneity for TCL included timing of MRI relative to biopsy.
Both 10 mm and 15 mm thresholds for TCL may be reasonable for clinical use. From comparison of the HSROC curves, ADC-mean may be superior to TCL at higher sensitivities.
3 TECHNICAL EFFICACY STAGE: 2.