MRI、MDCT检测肾癌下腔静脉癌栓及癌栓侵犯血管壁价值的系统评价

目的对MRI、MDCT检测下腔静脉癌栓及癌栓侵犯血管壁的价值进行系统评价。方法计算机检索PubMed、EMbase、Cochrane图书馆、MELINE（Ovid）、CBM、CNKI、VIP及WanFang Data的相关英文及中文文献，检索时限为2000年1月～2012年2月。按照纳入和排除标准选择文献、提取资料和评价纳入研究的方法学质量后，采用RevMan5、Meta—disc1．4软件对纳入文献进行异质性检验及Meta分析。结果共纳入6篇文献，244例患者，246例肾癌。Meta分析结果显示：MRI和MDCT组的敏感度分别为0．963、0．952，特异度分别为0．969、0．979，＋LR分别为9．759、15．57，-LR分别为0．091、0．108，dOR分别为198．71、251．54。各组合并效应量间均无统计学差异（P〉0．05）。MDCT组的SROC曲线下面积（AUC）为0．9818，Q^＊0．9407。结论MRI与MDCT诊断肾癌下腔静脉癌栓的差异无统计学意义。由于现有资料有限，今后还应更多地进行关于癌栓侵犯血管壁的原始研究。

Value of MRI and MDCT in Detecting Both Inferior Vena Cava Tumor Thrombus and Vena Cava Wall Invasion in Renal Cell Carcinoma: A Systematic Review

Objective To evaluate the value of MRI and MDCT in detecting both inferior vena cava tumor thrombus and vena cava wall invasion in renal cell carcinoma. Methods Databases including PubMed, EMbase, The Cochrane Library, MEDLINE （Ovid）, CBM, CNKI, VIP and WanFang Data were searched from January 2000 to February 2012. Relevant studies were screened on the basis of the inclusion and exclusion criteria, and then quality assessment and data extraction were conducted. Then heterogeneity test and meta-analysis were conducted using RevMan 5 and Meta-disc 1.4. Results A total of 6 trials involving 244 patients and 246 cases of renal cell carcinoma were included. The results of meta-analysis showed that, for the MRI group and the MDCT group, the sensitivity was 0.963 and 0.952, the specificity was 0.969 and 0.979, the value of ＋LR was 9.759 and 15.57, the value of -LR was 0.091 and 0.108, and the dOR was 198.71 and 251.54, respectively. There were no significant differences in pooled effect-size among groups （P〉0.05）. The area un- der curve （AUC） of summary ROC curve analysis as well as Q^＊ index of the MDCT group were 0.981 8 and 0.940 7, respectively. Conclusion There is no significant difference in the value of MRI and MDCT in detecting inferior vena cava tumor thrombus induced by renal cell carcinoma. More original studies on vena cava wall invasion by tumor thrombus should be conducted in the future due to the limitation of current materials.