CAJ | 학술논문

目的用Meta分析法综合评价18F-FDG PET显像对脑胶质瘤分级的能力.方法搜索Medline、中国期刊网关于18F-FDG PET显像诊断脑胶质瘤的中英文文献.提取文献中用半定量法或目测法判定胶质瘤恶性程度的数据,同时按照Cochrane工作组推荐的诊断评价标准进行文献的质量方法学评估.用Meta分析软件(Meta-Disc)对纳入文献汇总分析,获得汇总灵敏度(Se)和特异性(Sp)及其95%可信区间(CI),并绘制汇总受试者工作特征(SROC)曲线,计算曲线下面积(AUC).结果共获取文献17篇(英文16篇、中文1篇),其中11篇可获取用半定量法[肿瘤/皮质放射性比值(T/C)组及肿瘤/白质放射性比值(T/W)组]判定胶质瘤恶性程度的数据,共272例患者;9篇可获取以目测法判定胶质瘤恶性程度的数据,共481例患者(目测组,部分文献包含2种以上判定方法).通过异质性检验,分别采用不同效应模型进行分析.T/C组、T/W组和目测组的汇总Se分别为0.952,0.857和0.810;Sp分别为0.409,0.538和0.870;诊断比值(DOR)分别为11.746,22.066和15.282.汇总Se的95%CI分别为0.903～0.980、0.768～0.922和0.757～0.855;汇总Sp的95%CI 分别为0.318～0.504,0.431～0.642和0.819～0.911;汇总DOR的95%CI分别为5.368～25.702,7.077～68.800和3.716～62.851.3组AUC分别为0.8604,0.8373和0.8724.结论利用18F-FDGPET显像对脑胶质瘤进行恶性程度预测时,半定量组的Se较高,有利于阳性病例的检出,目测组Sp较高,有利于阴性病例的排除.根据AUC判断,目测组总体诊断效能最高,T/C组次之,T/W组再次.
목적 용Meta분석법종합평개18F-FDG PET현상대뇌효질류분급적능력.방법 수색Medline、중국기간망관우18F-FDG PET현상진단뇌효질류적중영문문헌.제취문헌중용반정량법혹목측법판정효질류악성정도적수거,동시안조Cochrane공작조추천적진단평개표준진행문헌적질량방법학평고.용Meta분석연건(Meta-Disc)대납입문헌회총분석,획득회총령민도(Se)화특이성(Sp)급기95%가신구간(CI),병회제회총수시자공작특정(SROC)곡선,계산곡선하면적(AUC).결과 공획취문헌17편(영문16편、중문1편),기중11편가획취용반정량법[종류/피질방사성비치(T/C)조급종류/백질방사성비치(T/W)조]판정효질류악성정도적수거,공272례환자;9편가획취이목측법판정효질류악성정도적수거,공481례환자(목측조,부분문헌포함2충이상판정방법).통과이질성검험,분별채용불동효응모형진행분석.T/C조、T/W조화목측조적회총Se분별위0.952,0.857화0.810;Sp분별위0.409,0.538화0.870;진단비치(DOR)분별위11.746,22.066화15.282.회총Se적95%CI분별위0.903～0.980、0.768～0.922화0.757～0.855;회총Sp적95%CI 분별위0.318～0.504,0.431～0.642화0.819～0.911;회총DOR적95%CI분별위5.368～25.702,7.077～68.800화3.716～62.851.3조AUC분별위0.8604,0.8373화0.8724.결론 이용18F-FDGPET현상대뇌효질류진행악성정도예측시,반정량조적Se교고,유리우양성병례적검출,목측조Sp교고,유리우음성병례적배제.근거AUC판단,목측조총체진단효능최고,T/C조차지,T/W조재차.
Objective To systematically review the efficiency of 18 F-FDG PET in glioma grading by using Meta-analysis. Methods Retrieval in PubMed and China National Knowledge Infrastructure (CNKI)was performed. Relevant papers concerning with glioma diagnoses with 18 F- FDG PET were selected. Paper quality was evaluated according to the standard of diagnostic test recommended by Cochrane Workshop. The data of glioma malignancy degree defined as semi-quantitatively and qualitatively were extracted from the papers. Meta-analysis was conducted with the Meta-Disc software to calculate pooled weighted sensitivity and specificity with 95% confidence interval (CI). Summary receiver operating characteristic (SROC) curve was performed and the areas under the curve (AUC) were calculated. Results Seven hundred and fifty-three patients from 17 papers ( 16 in English, 1 in Chinese) were included. Two hundred and seventy-two patients from 11 papers were using semi-quantitative (tumor to cortex ratio, T/C; tumor to white matter ratio,T/W) method and 481 patients from 9 papers were using qualitative method (visual observation, some of the papers had 2 or more methods). After heterogeneity test was done, different effect models were selected. The pooled weighted sensitivity, specificity and diagnostic odds ratio (DOR) with 95% CI for T/C group was 0. 952 (95% CI: 0. 903 -0. 980), 0. 409 (95% CI: 0. 318-0. 504) and 11. 746 (95% CI:5. 368-25. 702) respectively. The pooled weighted sensitivity, specificity and DOR with 95% CI for T/W group was 0. 857 (95% CI: 0. 768-0. 922), 0. 538 (95% CI: 0. 431 -0. 642) and 22. 066 (95% CI:7. 077-68. 800) respectively. The pooled weighted sensitivity, specificity and diagnostic odds ratio (DOR)with 95% CI for qualitative method was 0.810 (95%CI: 0.757-0.855), 0.870 (95%CI: 0. 819-0.911 ) and 15.282 (95% CI: 3. 716-62. 851 ) respectively. The AUC for T/C group, T/W group and qualitative method was 0.8604, 0. 8373 and 0. 8724 respectively. Conclusions Grading glioma by 18 F-FDG PET with semi-quantitative method may provide high diagnostic sensitivity. If qualitative method is used, the diagnostic specificity may be higher.