目的 評價超順磁性氧化鐵(SPIO)增強MRI對肝臟局灶性病變的檢出價值.
方法 計算機檢索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)文獻光盤數(shù)據(jù)庫 (1978.1～2004.7)、中文生物醫(yī)學(xué)期刊文獻數(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)文獻庫、相關(guān)醫(yī)藥公司文獻庫;手檢3種本專業(yè)雜志及相關(guān)文獻的參考文獻,并結(jié)合本科室自己的研究,全面搜集研究SPIO增強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,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,并對其進行方法學(xué)質(zhì)量評價和系統(tǒng)評價.
結(jié)果 共有10篇文獻符合納入標(biāo)準,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曲線法進行定量Meta分析,而只能進行描述性評價.本研究顯示SPIO增強MRI對肝臟局灶性病變檢測敏感度66%～100%,準確度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,未能進行Meta分析,故目前尚無確切證據(jù)表明SPIO增強MRI對肝臟局灶性病變有較高的診斷準確性.今后進行更多的大樣本、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)準和統(tǒng)一完善的參考標(biāo)準的影像診斷試驗,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
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| 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. 不同場強和序列的超順磁性氧化鐵磁共振增強掃描在肝癌檢出中的比較[J]. 中國醫(yī)學(xué)計算機成像雜志, 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.