Can diffusion-weighted magnetic resonance imaging (DW-MRI) alone be used as a reliable sequence for the preoperative detection and characterisation of hepatic metastases? A meta-analysis
A partir d'une revue systématique de la littérature publiée entre 2000 et 2012 (11 études, 537 patients), cette méta-analyse évalue la spécificité et la sensibilité d'une imagerie pondérée en diffusion par résonance magnétique pour détecter et identifier des métastases hépatiques avant une intervention chirurgicale
Purpose To perform a meta-analysis of all available studies of the diagnostic performance of diffusion-weighted magnetic resonance imaging (DW-MRI) in patients with hepatic metastases. Methods Databases including MEDLINE and EMBASE were searched for relevant original articles published from January 2000 to February 2012. We determined sensitivities and specificities across studies, calculated positive and negative likelihood ratios (LR+ and LR–), diagnostic odds ratio (DOR) and constructed summary receiver operating characteristic curves using hierarchical regression models. Results Across 11 studies (537 patients), DW-MRI sensitivity was 0.87 (95% confidence interval (CI), 0.80, 0.91) and specificity was 0.90 (95% CI, 0.86, 0.93). Overall, LR+ was 8.52 (95% CI, 6.17, 11.77), LR– was 0.15 (95% CI, 0.10, 0.22) and DOR was 57.36 (95% CI, 38.29, 85.93). In studies in which both DW-MRI and contrast-enhanced magnetic resonance imaging (CE-MRI) were performed, the comparison of DW-MRI performance with that of CE-MRI suggested no major differences against these two methods (p > 0.05). DW-MRI combined CE-MRI had higher sensitivity and specificity than DW-MRI alone (97% versus 86% and 91% versus 90%, respectively) (p < 0.05). The subgroup in which DW-MRI examinations were performed with a 3.0 Tesla (T) device had higher pooled specificity (0.91, 95% CI, 0.88–0.95) than the subgroup of DW-MRI with 1.5 T device (0.81, 95% CI, 0.67, 0.94) (p < 0.05). Average lesion size (⩽1.5 cm versus >1.5 cm) did not influence the diagnostic accuracy of the test (p > 0.05). Conclusion Our results demonstrate DW-MRI has good diagnostic performance in the overall evaluation of hepatic metastases and equivalent to CE-MRI. Combination of CE-MRI and DW-MRI can improve the diagnostic accuracy of magnetic resonance (MR) imaging. Our study further confirms that DW-MRI can accurately detect hepatic metastases regardless of the lesion size. It is suggested to perform DW-MRI by 3.0 T devices, which might have high specificity to identify liver metastases.
European Journal of Cancer , résumé, 2011