目的 評價超順磁性氧化鐵(SPIO)增強(qiáng)MRI對肝臟局灶性病變的檢出價值.
方法 計算機(jī)檢索MEDLINE (1966.1～2004.8)、EMBASE (1984～2004)、Cochrane 圖書館 (2004年第1期)、中國生物醫(yī)學(xué)文獻(xiàn)光盤數(shù)據(jù)庫 (1978.1～2004.7)、中文生物醫(yī)學(xué)期刊文獻(xiàn)數(shù)據(jù)庫 (1994～2004)、中文科技期刊全文數(shù)據(jù)庫 (1989～2004)、多個醫(yī)學(xué)影像學(xué)專業(yè)雜志及其互聯(lián)網(wǎng)文獻(xiàn)庫、相關(guān)醫(yī)藥公司文獻(xiàn)庫;手檢3種本專業(yè)雜志及相關(guān)文獻(xiàn)的參考文獻(xiàn),并結(jié)合本科室自己的研究,全面搜集研究SPIO增強(qiáng)MRI對肝臟局灶性病變檢出價值的影像診斷試驗.按制定的納入標(biāo)準(zhǔn),納入基于病灶-病灶分析的已發(fā)表和未發(fā)表的研究和觀察對象為臨床懷疑或其它影像學(xué)檢查懷疑有肝臟局灶性病變的文獻(xiàn),并對其進(jìn)行方法學(xué)質(zhì)量評價和系統(tǒng)評價.
結(jié)果 共有10篇文獻(xiàn)符合納入標(biāo)準(zhǔn),共包括418位病人的1 037個病灶,因所有試驗提供的數(shù)據(jù)均無法提取出完整的敏感度和特異度數(shù)據(jù),故不能用Cochrane協(xié)作網(wǎng)診斷與篩查小組推薦的SROC曲線法進(jìn)行定量Meta分析,而只能進(jìn)行描述性評價.本研究顯示SPIO增強(qiáng)MRI對肝臟局灶性病變檢測敏感度66%～100%,準(zhǔn)確度76%～97%,各研究結(jié)果間的差異較大.
結(jié)論 因研究的病例數(shù)較少,研究間異質(zhì)性較大,未能進(jìn)行Meta分析,故目前尚無確切證據(jù)表明SPIO增強(qiáng)MRI對肝臟局灶性病變有較高的診斷準(zhǔn)確性.今后進(jìn)行更多的大樣本、盲法觀察、納入不同大小和種類的病灶、有統(tǒng)一的分層標(biāo)準(zhǔn)和統(tǒng)一完善的參考標(biāo)準(zhǔn)的影像診斷試驗,是非常必要的.
引用本文： 帥丹丹,劉榮波,周翔平. 超順磁性氧化鐵增強(qiáng)MRI對肝臟局灶性病變檢出價值的評價. 中國循證醫(yī)學(xué)雜志, 2005, 05(3): 237-241. doi: 復(fù)制
版權(quán)信息： ?四川大學(xué)華西醫(yī)院華西期刊社《中國循證醫(yī)學(xué)雜志》版權(quán)所有，未經(jīng)授權(quán)不得轉(zhuǎn)載、改編
| 1. | 王莉, 田建明, 陸建平. 不同場強(qiáng)和序列的超順磁性氧化鐵磁共振增強(qiáng)掃描在肝癌檢出中的比較[J]. 中國醫(yī)學(xué)計算機(jī)成像雜志, 2002; 8(3): 177～182. |
| 2. | Ward J, Guthrie JA, Scott DJ, Achley J, Wilson D, Davies MH, Wyatt JI, Robinson PJ. Hepatocellular carcinoma in the cirrhotic liver: double-contrast MR imaging for diagnosis[J]. Radiology, 2000; 216(1): 154-162. |
| 3. | Wang L, Tian JM, Lu JP. Comparative study with different field strength and sequences in detect hepatic carcinoma using superparamagnetic iron oxide enhanced MR imaging[J]. Chinese Journal of Medical Computed Imaging, 2002; 8(3):177-182. |
| 4. | Takahama K, Amano Y, Hayashi H, Ishihara M, Kamazaki T. Detection and characterization of focal liver lesions using superparamagnetic iron oxide-enhanced magnetic resonance imaging: comparison between ferumoxides-enhanced T1-weighted imaging and delayed-phase gadolinium-enhanced T1-weighted imaging[J]. Abdom-Imaging, 2003; 28(4): 525-530. |
| 5. | Kim YK, Kim CS, Lee YH, Kwak HS, Lee JM. Comparison of superparamagnetic iron oxide-enhanced and gadobenate dimeglumine-enhanced dynamic MRI for detection of small hepatocellular carcinomas[J]. AJR Am J Roentgenol, 2004; 182(3):1 217-1 223. |
| 6. | Ssalamah AB, Peer GH, Schima W. Detection of focal hepatic lesions: comparison of unenhanced and SHU 555 A-enhanced MR imaging versus biphasic helical CTAP[J]. J-Magn-Reson-Imaging, 2000 ; 11(6): 665-672. |
| 7. | Blakeborough A, Ward J, Wilson D. Hepatic lesion detection at MR imaging: a comparative study with four sequences[J]. Radiology, 1997; 203(3):759-765. |
| 8. | Kim MJ, Kim JH, Chung JJ, Park MS, Lim JS, Oh YT. Focal hepatic lesions: detection and characterization with combination gadolinium- and superparamagnetic iron oxide-enhanced MR imaging[J]. Radiology, 2003; 228(3):719-726. |
| 9. | Ward J, Naik KS, Guthrie JA, Wilson D, Robinson PJ. Hepatic lesion detection: comparison of MR imaging after the administration of superparamagnetic iron oxide with dual-phase CT by using alternative-free response receiver operating characteristic analysis[J]. Radiology, 1999; 210(2): 459-466. |
| 10. | Hori M, Murakami T, Kim T, Tsuda K, Takahashi S, Okada A, Takamura M, Nakamura H. Detection of hypervascular hepatocellular carcinoma: comparison of SPIO-enhanced MRI with dynamic helical CT[J]. J Comput Assist Tomogr, 2002;26(5):701-710. |
- 1. 王莉, 田建明, 陸建平. 不同場強(qiáng)和序列的超順磁性氧化鐵磁共振增強(qiáng)掃描在肝癌檢出中的比較[J]. 中國醫(yī)學(xué)計算機(jī)成像雜志, 2002; 8(3): 177～182.
- 2. Ward J, Guthrie JA, Scott DJ, Achley J, Wilson D, Davies MH, Wyatt JI, Robinson PJ. Hepatocellular carcinoma in the cirrhotic liver: double-contrast MR imaging for diagnosis[J]. Radiology, 2000; 216(1): 154-162.
- 3. Wang L, Tian JM, Lu JP. Comparative study with different field strength and sequences in detect hepatic carcinoma using superparamagnetic iron oxide enhanced MR imaging[J]. Chinese Journal of Medical Computed Imaging, 2002; 8(3):177-182.
- 4. Takahama K, Amano Y, Hayashi H, Ishihara M, Kamazaki T. Detection and characterization of focal liver lesions using superparamagnetic iron oxide-enhanced magnetic resonance imaging: comparison between ferumoxides-enhanced T1-weighted imaging and delayed-phase gadolinium-enhanced T1-weighted imaging[J]. Abdom-Imaging, 2003; 28(4): 525-530.
- 5. Kim YK, Kim CS, Lee YH, Kwak HS, Lee JM. Comparison of superparamagnetic iron oxide-enhanced and gadobenate dimeglumine-enhanced dynamic MRI for detection of small hepatocellular carcinomas[J]. AJR Am J Roentgenol, 2004; 182(3):1 217-1 223.
- 6. Ssalamah AB, Peer GH, Schima W. Detection of focal hepatic lesions: comparison of unenhanced and SHU 555 A-enhanced MR imaging versus biphasic helical CTAP[J]. J-Magn-Reson-Imaging, 2000 ; 11(6): 665-672.
- 7. Blakeborough A, Ward J, Wilson D. Hepatic lesion detection at MR imaging: a comparative study with four sequences[J]. Radiology, 1997; 203(3):759-765.
- 8. Kim MJ, Kim JH, Chung JJ, Park MS, Lim JS, Oh YT. Focal hepatic lesions: detection and characterization with combination gadolinium- and superparamagnetic iron oxide-enhanced MR imaging[J]. Radiology, 2003; 228(3):719-726.
- 9. Ward J, Naik KS, Guthrie JA, Wilson D, Robinson PJ. Hepatic lesion detection: comparison of MR imaging after the administration of superparamagnetic iron oxide with dual-phase CT by using alternative-free response receiver operating characteristic analysis[J]. Radiology, 1999; 210(2): 459-466.
- 10. Hori M, Murakami T, Kim T, Tsuda K, Takahashi S, Okada A, Takamura M, Nakamura H. Detection of hypervascular hepatocellular carcinoma: comparison of SPIO-enhanced MRI with dynamic helical CT[J]. J Comput Assist Tomogr, 2002;26(5):701-710.