摘要
目的评价应用术中磁共振(intraoperative magnetic resonance imaging,iMRI)、术中超声(intraoperative ultrasound,i US)、5-氨酸乙酰丙酸荧光引导技术(fluorescence guided with 5-aminolevulinic acid,fluorescence guided with 5-ALA)对胶质瘤切除残留的诊断价值。材料与方法计算机检索Pubmed、Embase、the Cochrane Library、中国知网、万方数据库自建库起至2018年4月有关术中MRI、术中超声、术中荧光技术对脑胶质瘤残余肿瘤的诊断的相关文献。由2名研究者按照纳入及排除标准独立筛选文献,应用QUADAS-2对纳入文献进行质量评价。采用Meta-Disc 1.4、Stata 13.0软件进行分析,对敏感度(sensitivity,Sen)、特异度(specificity,Spe)、阳性似然比(positive likelihood ratio,PLR)、阴性似然比(negative likelihood ratio,NLR)、诊断比值比(diagnositc odds ratio,DOR)进行汇总分析并进行异质性检验,计算综合受试者工作曲线(summary receiver operating characteristic curve,SROC)并进行比较。结果最终纳入34篇文献,采用随机效应模型进行分析,iMRI、i US、5-ALA的汇总分析。Sen、Spe、PLR、NLR、DOR分别为0.698 (0.651,0.742)、0.819 (0.762,0.867)、3.815 (2.208,7.175)、0.230(0.110,0.484)、22.556(5.657,89.933),0.746(0.717,0.773)、0.872(0.850,0.892)、4.041(2.588,6.310)、0.313(0.227,0.433)、15.951(8.190,31.068),0.752(0.726,0.777)、0.862(0.839,0.882)、3.877(2.593,5.798)、0.313(0.230,0.425)、15.256 (8.309,28.046)。SROC的AUC分别为0.897、0.865、0.891,经Z检验发现其并无明显统计学意义。结论 iMRI,i US,5-ALA对胶质瘤切除后残余肿瘤的诊断具有重要的诊断价值,iMRI与iUS在显示切除瘤、周围水肿、血肿等可以提供重要的影像信息,iMRI的诊断效能略高于iUS、5-ALA,在术中可实时了解整体脑部的出血水肿等情况,而iUS的特异度略高于其他两种技术,一定程度上可以减少误诊率,这在功能区胶质瘤的手术具有极大的诊断意义,5-ALA荧光技术的敏感度较高,�
Objective: To evaluate the value of intraoperative magnetic resonance imaging, intraoperative ultrasound and intraoperative fluorescence guided with 5-aminolevulinic acid (5-ALA) in the diagnosis of residual glioma. Materials and Methods: Literatures on intraoperative MRI, intraoperative ultrasound and 5-ALA in the diagnosis of residual glioma were collected from Pubmed, Embase, the Cochrane Library, CNKI and Wanfang Database from the establishment of the database to April 2018. Two researchers independently screened the literature according to inclusion and exclusion criterias, and used QUADAS-2 to evaluate the quality of the included literatures. The sensitivity (Sen), specificity (Spe), positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic ratio (DOR) were analyzed by Meta- Disc 1.4 and Stata 13.0 software. The heterogeneity was tested and the summary receiver operating characteristic curve (SROC) was calculated. Results: Thirty-four papers were included and analyzed by random effect model. The Sen, Spe, PLR, NLR and DOR of iMRI, iUS and 5-ALA were 0.698 (0.651, 0.742), 0.819 (0.762, 0.867), 3.815 (2.208, 7.175), 0.230 (0.110, 0.484), 22.556 (5.657,89.933). 0.746 (0.717, 0.773), 0.872 (0.850, 0.892), 4.041 (2.588, 6.310), 0.313 (0.227, 0.433), 15.951 (8.190,31.068). 0.752 (0.726, 0.777), 0.862 (0.839, 0.882), 3.877 (2.593, 5.798), 0.313 (0.230, 0.425), 15.256 (8.309,28.046). The AUC of iMRI, iUS, 5-ALA were 0.897, 0.865, 0.891. There were no significant statistical significance by Z test. Conclusions: iMRI, iUS, 5-ALA have important diagnostic value for the diagnosis of residual tumor after glioma resection. iMRI and iUS can provide important imaging information of tumor resection, peripheral edema, hematoma, etc. The AUC of iMRI is slightly higher than that of iUS, 5-ALA.iMRI could provide real-time information of the overall brain hemorrhage and edema in the operation. The specificity of iUS is slightly higher than the other two technologies, and it can reduce the rate of misdiagnosis.
作者
叶冬熳
杨劭劼
于韬
YE Dongman;YANG Shaojie;YU Tao(Department of Diagnostic Ultrasound, Cancer Hospital of China Medical University, Liaoning Cancer Hosptial&Institute, Shenyang 110042, China;Department of Gynecology, the First Affiliated Hospital of China Medical University, Shenyang 110001, China)
出处
《磁共振成像》
CAS
2019年第5期342-347,共6页
Chinese Journal of Magnetic Resonance Imaging
关键词
磁共振成像
超声检查
荧光技术
监测
手术中
神经胶质瘤
基于文献的发现
magnetic resonance imaging
ultrasonography
fluorescence technology
monitoring, intraoperative
glioma
literature based discovery
