PET诊断结直肠癌复发价值及误诊原因的Meta分析

目的用Meta分析方法研究18^F-FDG PET在结直肠癌复发诊断中的价值，并探讨其主要的误诊原因。方法收集2007年2月8日前公开发表的关于PET对结直肠癌术后复发评估的所有中英文文献，对纳入文献进行方法学质量评估后，用统计软件计算综合灵敏度（Se）、特异性（Sp）、诊断优势比（DOR），并绘制综合受试者工作特征（SROC）曲线。结果共有19篇文献纳入。PET评价结直肠癌全身复发及转移的综合Se为89．5％[95％可信区间（CI）86.6％-92．0％]，综合Sp为78．3％（95％CI72．0％-83．8％）．综合DOR为28．114（95％CI12．120—65．216）；SROC曲线下面积为0．8857，Q^＊值为0．8163。结论18^F-FDG PET在结直肠癌术后复发诊断中有较高的价值。     

^11C—MET和^18F—FDG PET／CT诊断胶质瘤术后残余或复发的比较

目的探讨^11C甲基蛋氨酸（MET）PET／CT对胶质瘤术后残余或复发病灶的诊断价值,并与^18F-FDG进行比较。方法46例胶质瘤术后患者均行^11C—MET和^18F-FDGPET／CT颅脑显像,2次显像间隔时间在5d内。采用ROI技术计算肿瘤与对侧灰质和白质比值。胶质瘤残余或复发病灶的诊断根据手术或立体定向活组织病理学检查、MRI、CT等影像学检查及临床随访,随访时间〉6个月。统计学比较采用z。检验或独立样本t检验。结果46例胶质瘤术后患者中残余或复发者36例。^11C-MET、^18F-FDGPET／CT显像对残余或复发病灶诊断的灵敏度分别为94．4％（34／36）、47．2％（17／36）,χ2=19．429,P〈0．001;特异性分别为90．0％（9／10）、100％（10／10）,χ2＝1．053,P〉0．05;准确性分别为93．5％（43／46）、58．7％（27／46）,χ2=15．294,P〈0．001。半定量分析：^11C—MET肿瘤／灰质比值为1．68±0．23,明显高于^18F—FDG的1．13±0．51（t=5．877,P〈0．001）,^11C—MET肿瘤／白质比值为2．52±0．28,明显高于^18F—FDG的1．42±0．57（t=10．470,P〈0．001）。结论^11C-METPET／CT显像对胶质瘤术后残余或复发病灶的诊断具有一定的临床价值,并优于^18F—FDGPET／CT显像。     

^13N—NH3·H2O联合^18F-FDG显像鉴别诊断原发性中枢神经系统淋巴瘤和胶质瘤

目的探讨^13N-NH3·H2O联合^18F—FDGPET／CT显像在鉴别原发性中枢神经系统淋巴瘤（PCNSL）和胶质瘤中的价值。方法对2010年1月至2012年7月就诊的10例PCNSL患者[男7例,女3例,年龄43—74（59．10±12．47）岁]和15例胶质瘤患者[男8例,女7例,年龄14～72（46．73±19．61）岁]进行^13N-NH3·H2O和^18F—FDGPET／CT显像。以肿瘤与脑灰质摄取比（T／G）评价肿瘤的放射性摄取量。采用两样本t检验比较不同肿瘤对显像剂的摄取差异,通过判别函数分析两者联合的诊断效果。结果PCNSL组^18F—FDG的T／G值明显高于胶质瘤组,分别为3．27±1．21和1．57±0．39（t=5．630,P〈0．001）,而PCNSL组^13N—NH3·H2O的T／G值明显低于胶质瘤组,分别为1．43±0．26和2．12±0．69（t=-3．551,P〈0．01）。相对于^13N—NH3·H2O的T／G值,所有PCNSL病灶（14个）均表现为高的^18F-FDGT／G值,而77．8％（14／18）的胶质瘤病灶则显示相反的结果。利用判别函数分析,2种显像剂联合对肿瘤分类的整体准确性达96．9％（31／32）,仅1例胶质瘤病灶误判为PCNSL。结论^13N-NH3·H2O联合^18F-FDG有助于鉴别PCNSL和胶质瘤。     

CT 引导下经皮肺穿刺活检对肺部毛玻璃样病变诊断价值的 Meta分析

目的：应用 Meta分析方法探讨CT引导下经皮肺穿刺活检（PTNB）对肺部毛玻璃样病变（GGO）的诊断价值。方法系统检索PubMed、EMBASE、EBSCO、OVID 外文数据库以及中国期刊全文数据库（CNKI）、中国生物医学文献数据库（CBM ）、维普（VIP）和万方中文数据库,查找所有关于CT引导下PTNB诊断肺部GGO的相关文献。数据分析采用Stata 12．0和Meta‐Disc 1．4软件进行。结果纳入研究6篇（n＝341）。汇总灵敏度、特异度、阳性似然比（LR＋）、阴性似然比（LR－）、诊断比值比（DOR）、曲线下面积（AUC）及95％可信区间分别为0．92（0．86～0．95）、0．98（0．85～1．00）、49．03（5．72～420．18）、0．08（0．05～0．15）、586．24（65．18～5272．83）、0．99（0．98～1．00）。结论对于肺部GGO的诊断,CT引导下PTNB具有较高的灵敏度、特异度和准确率,可作为肺部GGO重要的临床诊断方法之一。     

用受试者工作特征曲线分析99Tcm-MIBI显像对甲状腺冷结节的诊断效能

目的探讨受试者工作特征（ROC）曲线分析99^Tc^m-MIBI显像对甲状腺冷结节的诊断效能。方法68例99^Tc^mO4^-甲状腺显像为单发冷结节的患者，行99^Tc^m-MIBI甲状腺显像，分别计算肿瘤和对侧正常甲状腺组织（T／N）15min（ER）和120min（DR）摄取比值，以TIN的DR=0．8作为诊断恶性病变的阈值。同时还计算肿瘤和颌下腺（T／S）、肿瘤和心脏（T／n）ER、DR，用ROC曲线分析法找出上述指标对甲状腺癌诊断的最佳阈值。结果经活组织检查或手术病理检查证实良性病变60例，恶性病变8例。半定量分析99^Tc^m-MIBI显像的灵敏度、特异性和准确性分别为100．0％、76．7％和79．4％，从ROC曲线的界值点找到DR最佳界点（TIN=0．995、T／S=0．995、T／H=1．005），以其作为诊断良恶性的阈值，三者的灵敏度分别为100．0％、87．5％、75．0％，特异性各为90．0％、85．0％、83．3％，其曲线下面积（AUC）分别为0．949，0．876，0．867，均大于相应的ER AUC。TIN阈值0．8和0．995对甲状腺癌诊断结果差异有统计学意义（χ^2=6．125，P〈0．05）。结论ROC曲线分析法能提高99^Tc^m-MIBI对甲状腺结节的诊断效能。     

DWI与DCE-MRI联合应用对乳腺良恶性病变鉴别诊断价值的Meta分析

目的 运用Meta分析方法研究近几年在最新技术条件下扩散加权成像(DWI)与动态对比增强磁共振成像(DCE-MRI)联合应用对乳腺良恶性病变的鉴别诊断价值.方法 检索PubMed、EMbase、Web of Science、Cochrane图书馆、中国期刊网(CNKI)的英文和中文文献,按照Cochrane协作网推荐的诊断试验纳入标准筛选文献,提取纳入研究的特征信息.文献评价采用诊断研究评价工具QUADAS-2.数据分析采用Meta-DiSc1.4软件,检验异质性,并根据异质性结果选择相应的效应模型.对所有研究进行加权定量合并,计算汇总灵敏度(Se)、汇总特异度(Sp).绘制汇总受试者工作特征曲线(SROC),并计算曲线下面积(AUC).结果 纳入28项研究,共1 707例患者、1 857个病灶.28项研究存在异质性,按照随机效应模型计算汇总Se、汇总Sp分别为93％、88％,SROC的AUC为0.96.结论 DWI与DCE-MRI联合应用对乳腺良恶性病变的鉴别诊断具有很高的灵敏度和特异度,是一种诊断效能较高的检查方法.     

CT血管成像和MR血管成像对颅内动脉瘤诊断价值的比较

目的 采用Meta分析法比较CT血管成像（computer tomography angiography，CTA）和MR血管成像（magnetic resonance angiography，MRA）对颅内动脉瘤的诊断价值。方法 检索Cochrane图书馆、Medline、Ovid数据库和中国期刊网中有关的中英文文献，按照Cochran协作网推荐的诊断试验纳入标准选取A级文献，并提取纳入研究的诊断信息。统计分析采用Meta-Test version 0．9软件，检验异质性，再根据异质性结果选择相应的效应模犁。对所纳入的研究予以加权定量合并，计算汇总敏感度和特异度及其95％可信区间，绘制汇总受试者工作特征曲线（SROC）。结果 按照纳入标准共获取文献11篇，其中有关CTA诊断颅内动脉瘤4篇（单层螺旋CT），MRA为5篇[三维时间飞跃法（3D TOF）]，二者共同研究者2篇；前瞻性研究7篇，回顾性4篇；各组研究均存在异质性，按照随机效应模型对纳入文献行汇总分析。结果显示，对于每个颅内动脉瘤CTA诊断的敏感度、特异度及95％可信区间分别为0．84（0．78～0．88）和0．77（0．68～0．84），MRA分别为0．68（0．63～0．72）和0．76（0．70～0．82）；SROC曲线下面积分别为95．40％和79．71％。结论 对于每个颅内动脉瘤，CTA诊断的准确性明显高于3D TOF法MRA。     

肺内病灶18F-FDG PET/CT显像与手术病理结果之对比研究

目的：评价^18F-脱氧葡萄糖（FGD）PET／CT显像在非小细胞肺癌（NSCLC）诊断中的价值及显像特征。方法：回顾性分析53例手术病例的碍F-FDGPET／CT显像诊断结果。PET／CT用目测法结合半定量法判断病灶良恶性，所得诊断结果与病理结果进行对照。结果：53个肺内病灶，49个恶性、4个良性，PET／CT正确诊断45个恶性病灶；灵敏度为91．8％，准确性为84．9％；4个良性病灶，其中炎性假瘤1例、结核3例。53例肺内病变，纵隔淋巴结病理诊断转移阳性者16例（45个淋巴结），PET／CT正确诊断10例，灵敏度为62．5％，纵隔淋巴结病理诊断阴性者37例（32个淋巴结），PET／CT正确诊断30例，特异性为81．1％，准确性为75．5％。结论：^18F-FDGPET／CF显像是评价肺内病灶良恶性的一种有效、无创性检查方法，有重要临床应用价值。     

MRA诊断颅内动脉瘤弹簧圈栓塞术后复发的meta分析

【摘要】　目的?系统评价磁共振血管成像（MRA）诊断颅内动脉瘤弹簧圈栓塞术（CIA）后复发的应用价值。 方法?计算机系统检索PubMed、EMbase、Cochrane Library、Web of Science、CBM、WanFang、VIP和CNKI等数据库,收集MRA诊断CIA后复发相关临床研究文献,截止至2018年8月。2名研究人员严格按照纳入和排除标准独立筛选文献和提取数据,并通过QUADAS-2标准评估偏倚风险,Stata 12.0软件作meta分析。 结果?共纳入15篇文献20项研究,包括803例患者894枚可疑复发颅内动脉瘤。Meta分析结果表明,MRA诊断CIA后复发的灵敏度（Sen）汇总为0.85（95%CI 0.77～0.90）,特异度（Spe）汇总为0.95（95%CI 0.91～0.98）,阳性似然比（PLR）汇总为18.20（95%CI 8.87～37.32）,阴性似然比（NLR）汇总为0.16（95%CI 0.10～0.25）,诊断比值比（DOR）汇总为113.86（95%CI 44.67～290.18）和受试者特征（ROC）曲线下面积（AUC）为0.96（95%CI 0.93～0.97）。亚组分析结果显示,1.5T MRA Sen和Spe分别大于3.0T MRA（0.87对0.72,P＜0.01;0.97对0.90, P＜0.05）。 结论?MRA对CIA后复发有明确的诊断价值。     

131I标记抗NRP-1单克隆抗体A6在荷瘤裸鼠体内分布和显像研究

目的制备131I标记的抗神经纤毛蛋白-1（NRP-1）单克隆抗体A6（131I-A6）,探讨其作为NRP-1靶向显像新型分子探针的可行性。方法（1）采用Iodogen法对A6进行131I标记,检测其标记率、放化纯和体外稳定性。（2）以人胶质瘤细胞株U87MG为实验细胞进行体外实验,测定131I—A6生物学活性、结合率及其与受体的亲和力。（3）将荷U87MG胶质瘤模型裸鼠采用随机抽样法分为5组,每组5只,分别于注射1．2MBq 131I-A6后24、48、72、96和120h处死,计算各脏器放射性摄取（％ID／g）、肿瘤／血液（T／B）和肿瘤／肌肉（T／M）比值。（4）取6只荷瘤裸鼠,以随机抽样法分为未阻断组和竞争阻断组,前组注射3．7MBq 131I-A6;后组注射3．7MBq 131I-A6和未标记的700仙gA6,均分别于注射后24、48、72、96和120h行SPECT／CT显像。采用两样本t检验对实验数据进行统计学分析。结果（1）131I—A6标记率为（95．46±3．34）％,放化纯〉95％;131I—A6在室温下PBS溶液中放置至96h,其放化纯仍〉85％。（2） 131I-A6与U87MG胶质瘤细胞特异性结合率1h达到最高值,为（15．80±1．30）％,在加入未标记的抗体A6时,U87MG细胞对131I-A6明显受抑制（t=2．862,P〈0．05）;与细胞表面抗原的亲和力（kd）为（1．67±0．14）nmol／L。（3）24h时131I—A6在荷瘤裸鼠血液放射性最高,为（8．00±1．42）％ID／g;其次是肝脏和肿瘤组织,分别为（7．68±1．56）和（6．00±1．24）％ID／g;脑、骨、肌肉组织放射性计数较低。给药后24h,T／B和T／M分别为0．78±0．10和3．20±0．30,随时间延长比值逐渐增高,在120h达到最高,分别为1．87±0．50和7．13±0．24。（4）体内显像示,注射 131I-A6后24h肿瘤略显影,随时间延长变清晰,120h显影为最清晰,阻断后未见肿瘤显影。结论 131I-A6的标记方法简单易行,标记率高,产物稳定性好,?     

18F-FDOPA与18F-FDG PET/CT诊断脑肿瘤的系统评价

目的 系统评价18F-FDOPA与18F-FDG PET/CT显像在脑肿瘤诊断中的临床价值.方法 采用Meta分析与直接比较方法.使用计算机检索中国期刊全文数据库、中文科技期刊数据库、万方数据库、中国生物医学文献数据库、PubMed、Embase、The Cochrane Library,从建库至2016年10月,搜索直接比较18F-FDOPA与18F-FDG PET/CT诊断脑肿瘤的诊断性试验.用Meta-Disc 1.4软件进行分析,计算两种不同显像剂的合并敏感度(sensitivity,SEN)、合并特异度(specificity,SPE)、合并阳性似然比(positive likelihood ratio,+LR)、合并阴性似然比(negative likelihood ratio,-LR)、诊断优势比(diagnostic odds ratio,DOR),并绘制综合受试者工作特征曲线计算曲线下面积(area under curve,AUC)与Q*值.结果 最终共纳入4篇文章,Meta 分析结果显示,18F-FDOPA PET/CT对脑肿瘤诊断的合并SEN为0.97(95％ CI =0.90 ～ 1.00),SPE为0.67(95％ CI =0.45 ～0.84),+LR为2.31 (95％ CI=1.40 ～3.81),-LR为0.07 (95％ CI =0.02～ 0.24),DOR为39.72(95％ CI=8.94～176.48),AUC为0.9725,Q*为0.9239.18F-FDG PET/CT对脑肿瘤诊断的合并SEN为0.51(95％CI=0.39～0.63),SPE为0.75(95％ CI=0.53 ～0.90,+LR为l.59(95％ CI=0.70 ～ 3.61),-LR为0.63(95％ CI =0.47 ～0.86),DOR为2.55(95％ CI =0.82 ～7.92),AUC为0.5848,Q*为0.5638.结论 18F-FDOPA PET/CT显像诊断脑肿瘤的敏感性比18F-FDG高,对脑肿瘤具有良好的诊断价值,可作为脑肿瘤诊断的方法之一.     

18F-FDG PET or PET/CT for detection of metastatic lymph nodes in patients with endometrial cancer: A systematic review and meta-analysis

The present study assessed the diagnostic performances of 18F-FDG PET or PET/CT in detecting pelvic and/or paraaortic lymph node metastasis in patients with endometrial cancer. METHODS: Through a search of MEDLINE (January 1998 to March 2011), an overall weighted average for sensitivity and specificity as well as pooled estimates of positive and negative likelihood ratios were calculated. A summary receiver-operating-characteristics (sROC) curve was constructed and the area under the sROC curve (AUC) was calculated. I-square was calculated to explore heterogeneity. RESULTS: The present study included 243 patients from seven studies. Results indicated a lack of significant heterogeneity for sensitivity and specificity (I(2)<50% and p>0.05). The overall pooled estimates for sensitivity and specificity of FDG-PET or PET/CT scans in the detection of pelvic and/or paraaortic metastasis were 63.0% (95% CI, 48.7-75.7%) and 94.7% (95% CI, 90.4-97.4%), respectively. The positive likelihood ratio was 10.465 (95% CI, 5.646-19.396) and the negative likelihood ratio 0.399 (95% CI, 0.284-0.560). The AUC was 0.9533. The overall diagnostic accuracy (Q* index) was 89.5%. Conclusion The high positive likelihood value confirms the reliability of a positive FDG-PET or PET/CT to detect pelvic and/or paraaortic lymph nodes metastasis in patients with untreated endometrial cancer. FDG-PET or PET/CT may prove beneficial to surgeons when selecting appropriate patients on whom to perform lymphadenectomy.     

18F-FDG PET for evaluation of bone marrow infiltration in staging of lymphoma: a meta-analysis.

The ability of PET with (18)F-FDG to evaluate bone marrow infiltration in patients with lymphoma has been a matter of extensive investigation with controversial results. Therefore, we aimed to evaluate systematically, with a meta-analysis, the diagnostic performance of (18)F-FDG PET in this setting. METHODS: Relevant studies were identified with MEDLINE and EMBASE searches (last update, August 2004). Data on the diagnostic performance of (18)F-FDG PET were combined quantitatively across eligible studies. We estimated weighted summary sensitivities and specificities, summary receiver-operating-characteristic (SROC) curves, and weighted summary likelihood ratios. We also conducted separate analyses according to various subgroups. Bone marrow biopsy (BMB) was used as the reference standard. RESULTS: Thirteen eligible nonoverlapping studies, which enrolled a total of 587 patients, were included in the meta-analysis. The independent random-effects weighted estimates of sensitivity and specificity against BMB were 51% (95% confidence interval [CI], 38%-64%) and 91% (95% CI, 85%-95%), respectively. Results were consistent in the SROC curve: a sensitivity of 51% corresponds to a specificity of 92%, whereas a specificity of 91% corresponds to a sensitivity of 55%. The weighted positive likelihood ratio (LR+) was 5.75 (95% CI, 348-9.48) and the negative likelihood ratio (LR-) was 0.67 (95% CI, 0.55-0.82). Six of 12 patients with positive (18)F-FDG PET and negative initial biopsy were found to have bone marrow involvement when biopsy was performed at the sites with positive imaging signals. Subgroup analyses showed better sensitivity in patients with Hodgkin's disease and in aggressive histologic types of non-Hodgkin's lymphoma than in patients with less aggressive histologic types and in studies using unilateral BMB compared with those using bilateral biopsy. CONCLUSION: This meta-analysis showed that (18)F-FDG PET has good, but not excellent, concordance with the results of BMB for the detection of bone marrow infiltration in the staging of patients with lymphoma. (18)F-FDG PET may complement the results of BMB and its performance may vary according to the type of lymphoma.     

Colour Doppler ultrasound assessment of well-functioning mature arteriovenous fistulas for haemodialysis access

OBJECTIVE: To summarize and compare the diagnostic accuracy of contrast and subtraction arthrography in the assessment of aseptic loosening of total hip arthroplasties. DESIGN: This meta-analysis was performed using methods described by the Cochrane Methods Group on Systematic Reviews of Screening and Diagnostic Tests. We included original, English-language papers published between January 1975 to October 2004 that examined contrast-enhanced arthrography with or without subtraction for diagnosis of loosening of total hip prostheses. A qualitative and quantitative analysis was performed by two investigators. RESULTS: With regard to the acetabular component, pooled sensitivity and specificity for contrast arthrography was 70% (95% confidence interval, 52-84) and 74% (95% CI, 53-87), respectively. Subtraction arthrography had a significantly higher sensitivity of 89% (95% CI, 84-93) (p=0.01), with a similar specificity of 76% (95% CI, 68-82). For the femoral component, pooled sensitivity and specificity for contrast arthrography were 63% (95% CI, 53-72) and 78% (95% CI, 68-86). Pooled estimates for subtraction arthrography revealed a significantly higher sensitivity of 86% (95% CI, 74-93) (p=0.003). Specificity was 85% (95% CI, 77-91) and was similar to the data of contrast arthrography (p=0.23). CONCLUSION: Using the present data we found that the subtraction arthrography is a sensitive technique for detection of loosening of total hip prostheses, offering added value over contrast arthrography, especially for evaluation of the femoral component.     

Diagnostic performance of USPIO-enhanced MRI for lymph-node metastases in different body regions: A meta-analysis

Objectives

USPIO (ultrasmall superparamagnetic iron oxide contrast agent) MRI was a promising imaging modality in the detection of lymph-node metastases. And this meta-analysis is performed to compare the diagnostic accuracy of USPIO-enhanced MRI with non-enhanced MRI, USPIO-enhanced MRI in various body regions, and postcontrast alone for diagnosis of lymph-node metastases.

Methods

A comprehensive and systematic search was conducted in PubMed and EMBASE databases. After a systematic review of the studies, sensitivity, specificity, the Q* value and other measures of accuracy of USPIO-enhanced MRI in the diagnosis of lymph-node metastases were summarized. The overall test performance was based on summary receiver operating characteristic curves.

Results

Summary of ROC curve analysis for per-lymph-node data shows a pooled sensitivity of 0.90 (95% confidential interval [CI]: 0.88-0.91) and overall specificity of 0.96 (95% CI: 0.95-0.97) for USPIO-enhanced MRI, the Q* value for USPIO-enhanced MRI is 0.9195, diagnostic odds ratio (DOR) is 162.28 (95% CI: 91.82-286.81). Non-enhanced MRI had less overall sensitivity 0.39 (95% CI: 0.34-0.43) and specificity 0.90 (95% CI: 0.89-0.91), respectively, the Q* value for USPIO-enhanced MRI was 0.6321, DOR is 5.81 (95% CI: 3.64-9.82). Postcontrast MRI alone had sensitivity 0.85 (95% CI: 0.81-0.88) and specificity 0.93 (95% CI: 0.91-0.95), respectively, the Q* value for USPIO-enhanced MRI was 0.8976, DOR is 76.92 (95% CI: 34.21-172.93). There was significant heterogeneity for studies reporting enhanced MRI and non-enhanced MRI.

Conclusions

This meta-analysis has shown that USPIO-enhanced MRI offers higher diagnostic performance than conventional MRI, and is sensitive and specific for the detection of lymph-node metastases. Postcontrast images alone can equate diagnostic performance pre- and postcontrast MRI has achieved for lymph-node characterization. And the role of USPIO-enhanced MRI in clinical practice still needs to be investigated in future studies.     

18F-FDG PET for the diagnosis and grading of soft-tissue sarcoma: a meta-analysis.

PET using (18)F-FDG is increasingly used for the diagnosis and grading of tumors. Several studies have been performed that evaluate the diagnostic and grading performance of (18)F-FDG PET for soft-tissue sarcoma, but each study has had a limited sample size. Therefore, we undertook a comprehensive meta-analysis of the evidence. METHODS: Relevant studies were identified from MEDLINE and EMBASE. Diagnostic and grading performance were evaluated for qualitative visualization; standard uptake value (SUV, cutoffs of 2.0 and 3.0); and metabolic rate of glucose (MRG, cutoff of 6.0 micro mol/100 g/min). Quantitative data synthesis included independent weighting of sensitivity and specificity, construction of summary receiver operating characteristic curves, and pooled analyses. RESULTS: The meta-analysis included 15 studies with 441 soft-tissue lesions (227 malignant, 214 benign). For diagnosis of malignant versus benign lesions, typical pairs of sensitivity and specificity estimates from the summary receiver operating characteristic curves were 92% and 73% for qualitative visualization; 87% and 79% for SUV 2.0; 70% and 87% for SUV 3.0; and 74% and 73% for MRG 6.0. Diagnostic performance was similar for primary and recurrent lesions. By qualitative interpretation, (18)F-FDG was positive in all intermediate/high-grade tumors (95% confidence interval [CI], 97.3%-100%), 74.4% (95% CI, 58.6%-85.9%) of low-grade tumors, and 39.3% (95% CI, 29.1%-50.3%) of benign lesions (including 11 of 12 inflammatory lesions). Using an SUV cutoff of 2.0, respective rates were 89.4% (95% CI, 79.4%-95.6%), 33.1% (95% CI, 15.6%-55.3%), and 19.1% (95% CI, 10.6%-30.5%). Limited data on comparisons with MRI and CT showed no differences against (18)F-FDG PET in diagnosing recurrent and metastatic disease. CONCLUSION: (18)F-FDG PET has very good discriminating ability in the evaluation of both primary and recurrent soft-tissue lesions. (18)F-FDG PET may be helpful in tumor grading but offers inadequate discrimination between low-grade tumors and benign lesions.     

Comparison of virtual cystoscopy and ultrasonography for bladder cancer detection: A meta-analysis

Background and purpose

Bladder cancer is the most commonly diagnosed malignancy in patients presenting with haematuria. Early detection is crucial for improving patient prognosis. We therefore performed a meta-analysis to evaluate and compare the detection validity (sensitivity and specificity) of virtual cystoscopy (VC) and ultrasonography (US).

Methods

We searched MEDLINE, EMBASE, PubMed and the Cochrane Library for studies evaluating diagnosis validity of VC and US between January 1966 and December 2009. Meta-analysis methods were used to pool sensitivity and specificity and to construct a summary receiver-operating characteristic (SROC) curve.

Results

A total of 26 studies that included 3084 patients who fulfilled all of the inclusion criteria were considered for inclusion in the analysis. The pooled sensitivity for bladder cancer detection using CT virtual cystoscopy (CTVC), MR virtual cystoscopy (MRVC) and US was 0.939 (95% CI, 0.919-0.956), 0.908 (95% CI, 0.827-0.959) and 0.779 (95% CI, 0.744-0.812), respectively. The pooled specificity for bladder cancer detection using CTVC, MRVC and US was 0.981 (95% CI, 0.973-0.988), 0.948 (95% CI, 0.884-0.983) and 0.962 (95% CI, 0.953-0.969), respectively. The pooled diagnostic odd ratio (DOR) estimate for CTVC (604.22) were significantly higher than for MRVC (144.35, P < 0.001) and US (72.472, P < 0.001).

Conclusion

Our results showed that both CTVC and MRVC are better imaging methods for diagnosing bladder cancer than US. CTVC has higher diagnostic value (sensitivity, specificity and DOR) for the detection of bladder cancer than either MRCT or US.     

A meta-analysis of the accuracy of prostate cancer studies which use magnetic resonance spectroscopy as a diagnostic tool

OBJECTIVE: We aimed to do a meta-analysis of the existing literature to assess the accuracy of prostate cancer studies which use magnetic resonance spectroscopy (MRS) as a diagnostic tool. MATERIALS AND METHODS: Prospectively, independent, blind studies were selected from the Cochrane library, Pubmed, and other network databases. The criteria for inclusion and exclusion in this study referenced the criteria of diagnostic research published by the Cochrane center. The statistical analysis was adopted by using Meta-Test version 6.0. Using the homogeneity test, a statistical effect model was chosen to calculate different pooled weighted values of sensitivity, specificity, and the corresponding 95% confidence intervals (95% CI). The summary receiver operating characteristic (SROC) curves method was used to assess the results. RESULTS: We chose two cut-off values (0.75 and 0.86) as the diagnostic criteria for discriminating between benign and malignant. In the first diagnostic criterion, the pooled weighted sensitivity, specificity, and corresponding 95% CI (expressed as area under curve [AUC]) were 0.82 (0.73, 0.89), 0.68 (0.58, 0.76), and 83.4% (74.97, 91.83). In the second criterion, the pooled weighted sensitivity, specificity, and corresponding 95% CI were 0.64 (0.55, 0.72), 0.86 (0.79, 0.91) and 82.7% (68.73, 96.68). CONCLUSION: As a new method in the diagnostic of prostate cancer, MRS has a better applied value compared to other common modalities. Ultimately, large scale RCT (randomized controlled trial) randomized controlled trial studies are necessary to assess its clinical value.     

Fluorine-18-fluorodeoxyglucose positron emission tomography to evaluate recurrent gastric cancer after surgical resection: a systematic review and meta-analysis

We aimed to explore the diagnostic accuracy of ¹⁸F-fluorodeoxyglucose positron emission tomography (¹⁸F-FDG PET) for detection of gastric cancer recurrence after surgical resection through a systematic review and meta-analysis. “PubMed”, EMBASE, Web of Knowledge and Springer, from the beginning of 2002 to Feb 2015, were searched for studies evaluating the diagnostic performance of 18F-FDG PET in detecting recurrent gastric cancer. We calculated sensitivities, specificities, diagnostic odds ratios and likelihood ratios, and constructed summary receiver operating characteristic curves. Fourteen studies (828 patients) were included. On a per-patient basis, the forest plots showed that the pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and diagnostic odds ratio of ¹⁸F-FDG PET or PET/CT were 0.85 [95 % confidence interval (CI) 0.75–0.92], 0.78 (95 % CI 0.72–0.84), 3.9 (95 % CI 2.9–5.4), 0.19 (95 % CI 0.11–0.34), and 21 (95 % CI 9–47), respectively. On a per-lesion basis, the pooled sensitivity was 0.75 (95 % CI 0.61–0.86). The area under the SROC curve of PET/CT on the basis of per-patient was 0.86. ¹⁸F-FDG PET had great value in the detection of gastric cancer recurrence after surgical resection. The sensitivities of ¹⁸F-FDG PET were 85 and 75 %, respectively, on per-patient basis and on per-lesion basis.     

Role of magnetic resonance spectroscopy for the differentiation of recurrent glioma from radiation necrosis: A systematic review and meta-analysis

PurposeDifferentiating glioma recurrence from radiation necrosis remains a great challenge. We conducted a meta-analysis to evaluate the diagnostic quality of magnetic resonance spectroscopy (MRS) in differentiating glioma recurrence from radiation necrosis.MethodsStudies about evaluation of MRS for the differential diagnosis of glioma recurrence from radiation necrosis were systematically searched in PubMed, Embase and Chinese Biomedical databases up to May 4, 2014. The data were extracted to perform heterogeneity test, threshold effect test and to calculate sensitivity (SEN), specificity (SPE) and areas under summary receiver operating characteristic curve (SROC).ResultsEighteen articles comprising a total sample size of 455 patients (447 lesions) with suspected glioma recurrence after radiotherapy, met all inclusion and exclusion criteria, and were included in our meta-analysis. Quantitative synthesis of studies showed that the pooled SEN and SPE for Cho/Cr ratio were 0.83 (95% CI: 0.77, 0.89) and 0.83 (95% CI: 0.74, 0.90). The area under the curve (AUC) under the SROC was 0.9001. The pooled SEN and SPE for Cho/NAA ratio were 0.88 (95% CI: 0.81, 0.93) and 0.86 (95% CI: 0.76, 0.93). The AUC under the SROC was 0.9185.ConclusionThis meta-analysis shows that MRS alone has moderate diagnostic performance in differentiating glioma recurrence from radiation necrosis using metabolite ratios like Cho/Cr and Cho/NAA ratio. It is strongly recommended that MRS should combine other advanced imaging technologies to improve diagnostic accuracy. This article underlines the importance of implementing multimodal imaging trials and multicentre trials in the future.