中国循证医学杂志

中国循证医学杂志

DCE-MRI 定量灌注参数鉴别直肠癌病理分级的 Meta 分析

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目的 系统评价动态对比增强磁共振成像(DCE-MRI)定量灌注参数 Ktrans、Kep 鉴别直肠癌病理分级的价值。 方法 计算机检索 PubMed、EMbase、Web of Science、The Cochrane Library(2017 年 1 期)、CBM、CNKI、VIP 和 WanFang Data 数据库,搜集 DCE-MRI 定量灌注参数 Ktrans、Kep 鉴别直肠癌病理分级的文献,检索时限均为 1990 年到 2017 年 2 月 6 日。由两位评价者独立筛选文献、提取资料,并采用 QUADAS-2 工具评价纳入研究的偏倚风险后,采用 STATA 12.0 软件进行 Meta 分析。 结果 共纳入 11 个研究,共计 618 名研究对象。Meta 分析结果显示:低分化组与中-高分化组间 Ktrans 值差异有统计学意义[SMD=1.123,95% CI(0.334,1.911),P=0.005],而两组间 Kep 值差异无统计学意义[SMD=0.233,95% CI(–0.173,0.639),P=0.260]。 结论 当前证据显示,Ktrans 可用于鉴别直肠癌病理分级,而 Kep 的临床应用价值尚需大样本原始研究进一步验证。

Objective To systematically review the value of the perfusion paramenters of Ktrans and Kep of dynamic contrast enhanced MRI(DCE-MRI) in distinguishing different histological grades of rectal cancer. Methods Databases such as PubMed, EMbase, Web of Science, The Cochrane Library (Issue 1, 2017), CBM, CNKI, WanFang Data and VIP were searched from 1990 to Feb 6th, 2017 to collect the studies according to the criteria. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies and then meta-analysis was performed by using STATA 12.0 software. Results A total of 11 studies involving 618 patients were included. The results of meta-analysis showed that there was significant difference of Ktrans between poorly differentiated grade and moderately-well differentiated grade (SMD=1.123, 95% CI 0.334 to 1.911,P=0.005), but there was no significant difference of Kep between these two groups (SMD=0.233, 95% CI –0.173 to 0.639,P=0.260). Conclusion Current evidence shows that Ktrans can be used to distinguish different histological grades of rectal cancer. The clinical application value of Kep still needs large sample original studies to further verify.

关键词: DCE-MRI; 定量灌注参数; Ktrans; Kep; 直肠癌; Meta 分析

Key words: DCE-MRI; Perfusion parameters; Ktrans; Kep; Rectal cancer; Meta-analysis

引用本文: 杨心悦, 肖晓娟, 卢宝兰, 余深平. DCE-MRI 定量灌注参数鉴别直肠癌病理分级的 Meta 分析. 中国循证医学杂志, 2017, 17(5): 536-543. doi: 10.7507/1672-2531.201608005 复制

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