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背景探讨确定T2加权成像(T2WI)和增强MR成像(CE-MRI)预测子宫内膜癌病人子宫肌层受侵程度的诊断能力。方法检索MEDLINE和EMBASE数据库的相关原创文献,时间为1995年1月—2012年3月。统计获得pooled分析需要的数据。结果共有11篇文献(548例病人)纳入本次研究。应用4个参数[pooled敏感度、pooled特异度、阳性预测值(PPV)和阴性预测值(NPV)]评估子宫肌层的受侵程度。对于CE-MRI,它们分别为0.81(95%CI:0.72～0.88)、0.72(95%CI:0.64～0.79)、0.65(95%CI:0.56～0.73)和0.85(95%CI:0.78~0.91);对于T2WI,它们分别为0.87(95%CI:0.78～0.94)、0.58(95%CI:0.47～0.69)、0.64(95%CI:0.54～0.73)和0.84(95%CI:0.73～0.92)。CE-MRI的pooled特异度值(0.72)明显高于T2WI(0.58)(P<0.05)。对于评估子宫肌层的深度受侵,CE-MRI和T2WI没有明显差异(P>0.05)。结论 CE-MRI可以很好地预测子宫肌层受侵程度,其结果优于T2WI。但是,CE-MRI的PPV值并不是最优。在评估子宫肌层深度受侵时,CE-MRI的NPV值相对较高。这种阴性结果提示子宫肌层没有深度受侵,可为规划治疗方案提供参考。要点①CE-MRI被广泛用于子宫内膜癌的检查。②CE-MRI可以很好地预测子宫肌层的受累情况。③CE-MRI预测子宫肌层的受累情况优于T2WI。④在评估子宫肌层深度受累时,CE-MRI的NPV值相对较高。
BACKGROUND: To determine the diagnostic ability of T2 weighted imaging (T2WI) and enhanced MR imaging (CE-MRI) to predict the extent of myometrial invasion in patients with endometrial cancer. Methods The related literatures about MEDLINE and EMBASE were searched from January 1995 to March 2012. Statistics obtained pooled analysis of the data needed. Results A total of 11 articles (548 patients) were included in this study. Four parameters [pooled sensitivity, pooled specificity, positive predictive value (PPV), and negative predictive value (NPV)] were used to assess the extent of myometrial invasion. They were 0.81 (95% CI: 0.72-0.88), 0.72 (95% CI: 0.64-0.79), 0.65 (95% CI 0.56-0.73) and 0.85 (95% CI 0.78-0.91 ); 0.58 (95% CI: 0.47-0.69), 0.64 (95% CI: 0.54-0.73) and 0.84 (95% CI: 0.73-0.92 ). The pooled specificity of CE-MRI (0.72) was significantly higher than that of T2WI (0.58) (P <0.05). There was no significant difference between CE-MRI and T2WI in assessing the depth of myometrial invasion (P> 0.05). Conclusion CE-MRI can predict the extent of myometrial invasion better than T2WI. However, the PPV value of CE-MRI is not optimal. In assessing the depth of myometrial invasion, CE-MRI has a relatively high NPV. This negative result suggests that there is no deep invasion of the myometrium, which can provide reference for the planning of treatment. Key points ① CE-MRI is widely used in the examination of endometrial cancer. ②CE-MRI can predict the myometrial involvement well. ③CE-MRI prediction of myometrial involvement is better than T2WI. ④ In assessing the depth of myometrial involvement, the NPV of CE-MRI is relatively high.