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肝细胞癌(hepatocellular carcinoma,HCC)是世界上最常见的恶性肿瘤,是全球癌症相关死亡的主要原因之一[1]。HCC微血管侵犯(microvascular invasion,MVI)是指显微镜下侵犯门静脉或肝静脉终末分支等小血管的微转移癌栓及血管腔内衬覆的肿瘤细胞巢团[2-4];HCC发生MVI的概率为15.0%~57.1%[5]。据报道,HCC MVI阳性患者的术后复发率是其阴性患者的4.4倍[6],是影响HCC根治性切除手术成功与否的最重要因素[7],亦是影响肝移植患者总生存率及特异生存率的独立危险因素[3, 8]。然而,MVI主要依靠术后组织病理学检查的诊断结果,存在一定的滞后性。近年来,诸多研究者采用磁共振表观扩散系数(apparent diffusion coefficient,ADC)的平均值(ADC mean value,ADCmean)和最小值(ADC minimum value,ADCmin)对HCC MVI进行术前预测[9-22],其中部分研究者认为ADCmean不能术前预测HCC MVI[9, 19, 22];部分研究结果表明更低的ADC值才能术前预测HCC MVI[10, 13];而部分研究者在ADCmean和ADCmin术前预测HCC MVI阳性诊断效能的优劣上存在分歧[9, 11-12, 16]。因此,我们通过系统评价,探讨和比较ADCmean 和ADCmin术前预测HCC MVI的诊断价值,旨在为后续研究及临床决策提供参考。
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根据纳入、排除标准检索获得文献2669篇,去除重复文献934篇,阅读文题、摘要初筛排除1674篇,通读全文排除48篇,最终纳入13篇文献[9-21]进行Meta分析。
在纳入的13篇文献中,共1432例HCC患者,2303个HCC病灶。其中研究ADCmean共1474个HCC病灶(MVI阳性615个、MVI阴性859个);研究ADCmin共829个HCC病灶(MVI阳性364个、MVI阴性465个)。纳入研究的基本特征和质量评价结果见表1,ADCmean和ADCmin术前预测HCC MVI的诊断参数见表2。
研究者 发表
年份出版
国家研究
类型是否采用
盲法“金标准” 年龄
(均数,岁)例数
(男/女)MRI厂家
及型号b值数/最大b值
(s/mm2)MVI(+/−)
病灶数QUADAS-2量
表评分(分)李旭辉等[9] 2020 中国 回顾性 不清楚 组织病理学检查 50.3 84(65/19) GE1.5T 2/700 31/53 12 Suh等[10] 2012 韩国 回顾性 是 组织病理学检查 56.0 65(54/11) 西门子3.0T 3/800 31/36 13 张坤等[11] 2017 中国 回顾性 不清楚 组织病理学检查 54.0 321(279/42) GE1.5T 1/800 67/254 10 胡艳等[12] 2019 中国 回顾性 是 组织病理学检查 49.4 40(33/7) Philips3.0T 2/800 17/23 13 Xu等[13] 2014 中国 回顾性 是 组织病理学检查 53.2 92(80/12) 西门子1.5T 2/500 39/70 13 周牮等[14] 2018 中国 回顾性 是 组织病理学检查 50.1 133(84/49) 西门子3.0T 2/800 36/97 12 李宏翔等[15] 2018 中国 前瞻性 是 组织病理学检查 51.0 31(29/2) Philips3.0T 9/1000 18/16 12 Zhao等[16] 2017 中国 回顾性 是 组织病理学检查 59.0 318(258/60) GE1.5T 2/800 211/107 13 Wei等[17] 2019 中国 前瞻性 是 组织病理学检查 52.0 115(78/37) GE3.0T 13/1200 55/80 14 Okamura等[18] 2016 日本 回顾性 是 组织病理学检查 67.0 75(54/21) 西门子1.5T 2/1000 33/42 13 Li等[19] 2018 中国 回顾性 是 组织病理学检查 51.5 41(38/3) Philips3.0T 10/1000 21/20 13 Zhao等[20] 2018 中国 回顾性 是 组织病理学检查 50.6 51(43/8) GE3.0T 13/1000 18/33 13 张倩等[21] 2019 中国 回顾性 不清楚 组织病理学检查 51.1 66(57/9) 西门子1.5T 2/700 38/28 10 注:HCC为肝细胞癌;MVI为微血管侵犯;MRI为磁共振成像;QUADAS为诊断试验质量评价工具。GE表示美国GE公司;西门子表示德国西门子公司;Philips表示荷兰飞利浦公司 表 1 术前定量预测HCC MVI纳入研究的基本特征及质量评价
Table 1. Basic characteristics and quality evaluation for preoperative quantitative prediction of microvascular invasion in hepatocellular carcinoma
研究者 项目 MVI(+) MVI(−) 最佳诊断阈值
(×10−3 mm2/s)灵敏度
(%)特异度
(%)真阳性
(例)假阳性
(例)假阴性
(例)真阴性
(例)病灶数 均数±标准差 病灶数 均数±标准差 张坤等[11] ADCmean 67 1.03±0.29 254 1.14±0.24 1.01 55.22 71.65 37 72 30 182 ADCmin 67 0.87±0.30 254 0.98±0.25 0.92 65.67 61.42 44 98 23 156 胡艳等[12] ADCmean 17 0.772±0.142 23 0.930±0.138 0.826 76.47 82.60 13 4 4 19 ADCmin 17 0.697±0.139 23 0.872±0.132 0.709 64.70 95.65 11 1 6 22 Zhao等[16] ADCmean 211 1.07±0.16 107 1.19±0.17 1.19 79.15 50.47 167 53 44 54 ADCmin 211 0.92±0.18 107 1.06±0.17 0.98 62.56 65.42 132 37 79 70 张倩等[21] ADCmean 38 1.171±0.269 28 1.230±0.478 − − − − − − − ADCmin 38 1.019±0.253 28 1.090±0.372 − − − − − − − 李旭辉等[9] ADCmean 31 1.171±0.119 53 1.219±0.136 − − − − − − − ADCmin 31 0.850±0.179 53 1.058±0.127 0.959 80.0 88.7 25 6 6 47 Wei等[17] ADCmean 55 1.07±0.27 80 1.37±0.37 1.19 70.9 65.0 39 28 16 52 Suh等[10] ADCmean 31 0.98±0.04 36 1.21±0.06 1.11 93.5 72.2 29 10 2 26 Okamura 等[18] ADCmean 33 1.080±0.421 42 1.310±0.487 1.175 75.8 77.5 25 9 8 33 Li等[19] ADCmean 21 1.46±0.32 20 1.74±0.57 0.739 76.2 65.0 16 7 5 13 Zhao等[20] ADCmean 18 1.35±0.22 33 1.59±0.49 1.46 60.6 88.9 11 4 7 29 Xu等[13] ADCmean 39 1.22±0.38 70 1.43±0.36 1.227 66.7 78.6 26 15 13 55 周牮等[14] ADCmean 36 1.062±0.234 97 1.250±0.252 1.138 69.4 67.0 25 32 11 65 李宏翔等[15] ADCmean 18 1.15±0.26 16 1.44±0.38 1.3 83.3 62.5 15 6 3 10 注:ADC为表观扩散系数;HCC为肝细胞癌;MVI为微血管侵犯;ADCmean为ADC平均值;ADCmin为ADC最小值。−表示无此项数据 表 2 比较ADC平均值与最小值术前定量预测HCC MVI的诊断参数
Table 2. Comparing the mean and minimum ADC values for preoperative quantitative prediction of microvascular invasion in hepatocellular carcinoma of diagnostic parameters
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诊断性研究结果显示,涉及ADCmean 的研究有11项 (r=0.397,P=0.226),涉及ADCmin 的研究有4项 (r=0.0001,P=0.999),Spearman相关系数提示均不存在阈值效应。以合并灵敏度判断非阈值效应引起的异质性研究结果显示,ADCmean的合并灵敏度存在一定异质性(I2=61.8%,P=0.004),则将随机效应模型合并;ADCmin的合并灵敏度无明显异质性(I2=29.2%,P=0.237),则将固定效应模型合并。连续性数据研究结果显示,ADCmean的MD存在明显异质性(I2=80%,P<0.001),则将随机效应模型合并,ADCmin的MD无明显异质性(I2=21%,P=0.280),则将固定效应模型合并。
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分析所有纳入文献的结果显示,李旭辉等[9] 和Suh 等[10]研究的Youden指数最大,以最大Youden指数确定ADCmean和ADCmin术前诊断HCC MVI阳性的最佳阈值分别为1.11×10−3 mm2/s和0.959×10−3 mm2/s。MVI阳性病灶的ADCmean和ADCmin明显低于MVI阴性病灶,如图1~2所示。汇总并比较ADCmean和ADCmin术前定量预测HCC MVI的各项诊断效应指标见表3。
图 1 表观扩散系数平均值鉴别肝细胞癌是否合并微血管侵犯的森林图
Figure 1. The mean ADC value identifies the forest plot of whether hepatocellular carcinoma incorporates microvascular invasion or not
图 2 表观扩散系数最小值鉴别肝细胞癌是否合并微血管侵犯的森林图
Figure 2. The minimum ADC value identifies the forest plot of whether hepatocellular carcinoma incorporates microvascular invasion or not
合并诊断效应指标 ADC平均值 ADC最小值 Z值 P值 灵敏度(95%CI) 0.74(0.70~0.77)a 0.65(0.60~0.70)b −0.917 0.359 特异度(95%CI) 0.69(0.66~0.72)a 0.68(0.63~0.72)a −0.525 0.600 阳性似然比(95%CI) 2.35(1.93~2.88)a 2.78(1.58~4.90)a − − 阴性似然比(95%CI) 0.43(0.37~0.49)b 0.46(0.32~0.64)a − − 诊断比值比(95%CI) 5.27(4.17~6.65)b 7.45(2.70~20.56)a − − 曲线下的面积 0.7722 0.7326 −0.131 0.896 注:a表示随机效应模型合并;b表示固定效应模型合并;−表示无此项数据。ADC为表观扩散系数;CI为置信区间 表 3 比较ADC平均值与最小值术前定量预测肝细胞癌微血管侵犯阳性的诊断效应指标
Table 3. Comparing the mean and minimum ADC values for preoperative quantitative prediction of microvascular invasion in hepatocellular carcinoma of efficacy indicators
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按照磁场强度、发表年份、b值数、MVI阳性与阴性病灶数的比值、是否采用盲法分为各亚组,探讨异质性的来源,各亚组的具体数据结果见表4。
项目 文献数
(篇)合并灵敏度(95%CI) I2值 Z值 P值 合并特异度(95%CI) I2值 Z值 P值 ADCmin 4 发表年份 −0.775 0.439 −1.549 0.121 ≥2019 2 0.75(0.60~0.86) 30.9% 0.91(0.82~0.96) 5.6% <2019 2 0.63(0.57~0.69) 0 0.63(0.57~0.68) 0 是否采用盲法 −1.549 0.121 −0.775 0.439 是 2 0.63(0.56~0.69) 0 0.71(0.62~0.78) 90.8% 不清楚 2 0.70(0.60~0.79) 58.2% 0.66(0.61~0.71) 94.1% ADCmean 11 MVI(+/−)病灶数的比值 −2.670 0.008 −1.332 0.183 ≥0.6 7 0.79(0.74~0.83) 21.6% 0.64(0.58~0.69) 65.5% <0.6 4 0.62(0.54~0.69) 0 0.73(0.69~0.77) 59.6% 磁场强度 −0.763 0.446 −0.095 0.924 3.0 T 7 0.76(0.69~0.81) 44.7% 0.70(0.65~0.75) 39.6% 1.5 T 4 0.73(0.68~0.77) 79.8% 0.68(0.64~0.73) 86.3% b值数≥2且b值≥800 −1.903 0.057 −0.712 0.476 是 9 0.77(0.73~0.81) 31.5% 0.66(0.62~0.71) 69.7% 否 2 0.59(0.49~0.69) 26.1% 0.73(0.68~0.78) 27.8% 注:ADC为表观扩散系数;MVI为微血管侵犯;ADCmin为ADC最小值;ADCmean为ADC平均值;CI为置信区间 表 4 比较ADC平均值与最小值术前预测肝细胞癌MVI的亚组分析
Table 4. Comparing the mean and minimum ADC values for preoperative quantitative prediction of microvascular invasion in hepatocellular carcinoma of subgroup analysis
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ADCmean的MD存在较高异质性,逐一排除每一项研究后,灵敏度分析结果显示,ADCmean术前鉴别HCC MVI的合并值为−0.68(95%CI :−0.80~−0.57,图3),这提示纳入文献的研究结果可靠且稳定。
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ADCmean的Egger's漏斗图(t=−1.58,P=0.144)和ADCmin的Egger's漏斗图(t=−0.71,P=0.530)结果显示,纳入文献不存在发表偏倚。
比较ADC平均值与最小值术前定量预测HCC微血管侵犯的诊断价值:Meta分析
Comparison of the mean and minimum value of apparent diffusion coefficient for preoperative quantitative prediction of microvascular invasion in hepatocellular carcinoma: a Meta-analysis
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摘要:
目的 探讨磁共振表观扩散系数(ADC)值术前预测肝细胞癌(HCC)微血管侵犯(MVI)的可行性,并比较ADC平均值(ADCmean)和ADC最小值(ADCmin)术前定量预测HCC MVI的诊断效能。 方法 检索PubMed、Embase、Web of Science、Cochrane Library和中国知网、万方数据库中关于磁共振ADC对HCC MVI诊断的相关研究,检索时间从建库至2020年10月。根据纳入与排除标准筛选文献,提取研究的基本特征和诊断参数,采用诊断试验质量评价工具-2量表对研究质量进行评分。绘制总受试者工作特征(SROC)曲线,计算曲线下面积(AUC),组间差异的比较采用Mann-Whitney U检验。采用Egger's漏斗图及独立样本t检验比较纳入文献的发表偏倚。 结果 最终纳入13篇文献,共1432例HCC患者,2303个HCC病灶。MVI阳性病灶的ADCmean和ADCmin明显低于MVI阴性病灶,组间的均数差分别为−0.17×10−3 mm2/s [95%CI:(−0.23~−0.12)×10−3 mm2/s,Z=6.58,P<0.001]和−0.15×10−3 mm2/s [95%CI:(−0.18~−0.12)×10−3 mm2/s,Z=9.91,P<0.001]。以最大Youden指数确定ADCmean和ADCmin术前诊断HCC MVI阳性的最佳阈值分别为1.11×10−3 mm2/s和0.959×10−3 mm2/s。ADCmean和ADCmin术前定量预测HCC MVI阳性的合并灵敏度分别为0.74和0.65、特异度分别为0.69和0.68、SROC的AUC分别为0.7722和0.7326,差异均无统计学意义(Z=−0.917、−0.525、−0.131,均P>0.05)。亚组分析结果显示,发表年份、MVI阳性与阴性病灶数的比例及b值数可能为异质性来源。ADCmean和ADCmin的Egger's漏斗图结果显示,差异均无统计学意义(无发表偏倚,t=−1.58、−0.71,均P>0.05)。 结论 ADC值可作为一种可靠、无创的术前定量预测HCC MVI的检查指标。与ADCmin相比,ADCmean术前定量预测HCC MVI阳性的诊断效能更优。 Abstract:Objective To investigate the feasibility of magnetic resonance apparent diffusion coefficient (ADC) value for preoperative quantitative prediction of microvascular invasion (MVI) in hepatocellular carcinoma (HCC) and to compare the diagnostic efficacy of ADC mean value (ADCmean) and ADC minimum value (ADCmin) for preoperative quantitative prediction of MVI in HCC. Methods PubMed, Embase, Web of Science, Cochrane Library, CNKI, and Wanfang data were researched from establishment to October 2020. Literature was screened in accordance with the inclusion and exclusion criteria; the basic characteristics and diagnostic parameters of the study were extracted, and the research quality was scored using the quality assessment of diagnostic accuracy studies-2 scale. The summary receiver operating characteristic (SROC) curve was drawn, and the area under curve (AUC) was calculated. In addition, the Mann-Whitney U test was used to compare the differences among the groups. Egger's funnel chart and independent sample t test were used to compare the publication bias for the included literature. Results A total of 13 up-to-standard literature with 1432 cases of HCC (2303 lesions of HCC) were included in the meta-analysis. ADCmean and ADCmin in MVI-positive lesions were significantly lower than those in MVI-negative lesions, with mean differences of −0.17×10−3 mm2/s (95%CI: (−0.23 – −0.12)×10−3 mm2/s, Z=6.58, P<0.001) and −0.15×10−3 mm2/s (95% CI: (−0.18 – −0.12)×10−3 mm2/s, Z=9.91, P<0.001), respectively. Moreover, the best cutoff values of ADCmean and ADCmin for preoperative diagnosis of HCC MVI were 1.11×10−3 mm2/s and 0.959×10−3 mm2/s, respectively, based on the maximum Youden index. The pooled sensitivity of ADCmean and ADCmin in the preoperative quantitative prediction of MVI-positive lessions with HCC was 0.74 and 0.65; the specificity was 0.69 and 0.68, and SROC AUC was 0.7722 and 0.7326, respectively. However, this result showed no significant difference (Z=−0.917, −0.525, −0.131; all P>0.05). Furthermore, subgroup analysis showed that the year of publication, MVI positive and negative ratio, and the number of b-values might cause heterogeneity, and Egger's funnel plots of ADCmean and ADCmin showed no statistically significance (no publication bias; t=−1.58, −0.71; both P>0.05). Conclusions The ADC value can be used as a reliable and noninvasive indicator for preoperative quantitative prediction of MVI in HCC. Compared with ADCmin, ADCmean has superior diagnostic efficacy in predicting MVI-positive patients with HCC. -
表 1 术前定量预测HCC MVI纳入研究的基本特征及质量评价
Table 1. Basic characteristics and quality evaluation for preoperative quantitative prediction of microvascular invasion in hepatocellular carcinoma
研究者 发表
年份出版
国家研究
类型是否采用
盲法“金标准” 年龄
(均数,岁)例数
(男/女)MRI厂家
及型号b值数/最大b值
(s/mm2)MVI(+/−)
病灶数QUADAS-2量
表评分(分)李旭辉等[9] 2020 中国 回顾性 不清楚 组织病理学检查 50.3 84(65/19) GE1.5T 2/700 31/53 12 Suh等[10] 2012 韩国 回顾性 是 组织病理学检查 56.0 65(54/11) 西门子3.0T 3/800 31/36 13 张坤等[11] 2017 中国 回顾性 不清楚 组织病理学检查 54.0 321(279/42) GE1.5T 1/800 67/254 10 胡艳等[12] 2019 中国 回顾性 是 组织病理学检查 49.4 40(33/7) Philips3.0T 2/800 17/23 13 Xu等[13] 2014 中国 回顾性 是 组织病理学检查 53.2 92(80/12) 西门子1.5T 2/500 39/70 13 周牮等[14] 2018 中国 回顾性 是 组织病理学检查 50.1 133(84/49) 西门子3.0T 2/800 36/97 12 李宏翔等[15] 2018 中国 前瞻性 是 组织病理学检查 51.0 31(29/2) Philips3.0T 9/1000 18/16 12 Zhao等[16] 2017 中国 回顾性 是 组织病理学检查 59.0 318(258/60) GE1.5T 2/800 211/107 13 Wei等[17] 2019 中国 前瞻性 是 组织病理学检查 52.0 115(78/37) GE3.0T 13/1200 55/80 14 Okamura等[18] 2016 日本 回顾性 是 组织病理学检查 67.0 75(54/21) 西门子1.5T 2/1000 33/42 13 Li等[19] 2018 中国 回顾性 是 组织病理学检查 51.5 41(38/3) Philips3.0T 10/1000 21/20 13 Zhao等[20] 2018 中国 回顾性 是 组织病理学检查 50.6 51(43/8) GE3.0T 13/1000 18/33 13 张倩等[21] 2019 中国 回顾性 不清楚 组织病理学检查 51.1 66(57/9) 西门子1.5T 2/700 38/28 10 注:HCC为肝细胞癌;MVI为微血管侵犯;MRI为磁共振成像;QUADAS为诊断试验质量评价工具。GE表示美国GE公司;西门子表示德国西门子公司;Philips表示荷兰飞利浦公司 表 2 比较ADC平均值与最小值术前定量预测HCC MVI的诊断参数
Table 2. Comparing the mean and minimum ADC values for preoperative quantitative prediction of microvascular invasion in hepatocellular carcinoma of diagnostic parameters
研究者 项目 MVI(+) MVI(−) 最佳诊断阈值
(×10−3 mm2/s)灵敏度
(%)特异度
(%)真阳性
(例)假阳性
(例)假阴性
(例)真阴性
(例)病灶数 均数±标准差 病灶数 均数±标准差 张坤等[11] ADCmean 67 1.03±0.29 254 1.14±0.24 1.01 55.22 71.65 37 72 30 182 ADCmin 67 0.87±0.30 254 0.98±0.25 0.92 65.67 61.42 44 98 23 156 胡艳等[12] ADCmean 17 0.772±0.142 23 0.930±0.138 0.826 76.47 82.60 13 4 4 19 ADCmin 17 0.697±0.139 23 0.872±0.132 0.709 64.70 95.65 11 1 6 22 Zhao等[16] ADCmean 211 1.07±0.16 107 1.19±0.17 1.19 79.15 50.47 167 53 44 54 ADCmin 211 0.92±0.18 107 1.06±0.17 0.98 62.56 65.42 132 37 79 70 张倩等[21] ADCmean 38 1.171±0.269 28 1.230±0.478 − − − − − − − ADCmin 38 1.019±0.253 28 1.090±0.372 − − − − − − − 李旭辉等[9] ADCmean 31 1.171±0.119 53 1.219±0.136 − − − − − − − ADCmin 31 0.850±0.179 53 1.058±0.127 0.959 80.0 88.7 25 6 6 47 Wei等[17] ADCmean 55 1.07±0.27 80 1.37±0.37 1.19 70.9 65.0 39 28 16 52 Suh等[10] ADCmean 31 0.98±0.04 36 1.21±0.06 1.11 93.5 72.2 29 10 2 26 Okamura 等[18] ADCmean 33 1.080±0.421 42 1.310±0.487 1.175 75.8 77.5 25 9 8 33 Li等[19] ADCmean 21 1.46±0.32 20 1.74±0.57 0.739 76.2 65.0 16 7 5 13 Zhao等[20] ADCmean 18 1.35±0.22 33 1.59±0.49 1.46 60.6 88.9 11 4 7 29 Xu等[13] ADCmean 39 1.22±0.38 70 1.43±0.36 1.227 66.7 78.6 26 15 13 55 周牮等[14] ADCmean 36 1.062±0.234 97 1.250±0.252 1.138 69.4 67.0 25 32 11 65 李宏翔等[15] ADCmean 18 1.15±0.26 16 1.44±0.38 1.3 83.3 62.5 15 6 3 10 注:ADC为表观扩散系数;HCC为肝细胞癌;MVI为微血管侵犯;ADCmean为ADC平均值;ADCmin为ADC最小值。−表示无此项数据 表 3 比较ADC平均值与最小值术前定量预测肝细胞癌微血管侵犯阳性的诊断效应指标
Table 3. Comparing the mean and minimum ADC values for preoperative quantitative prediction of microvascular invasion in hepatocellular carcinoma of efficacy indicators
合并诊断效应指标 ADC平均值 ADC最小值 Z值 P值 灵敏度(95%CI) 0.74(0.70~0.77)a 0.65(0.60~0.70)b −0.917 0.359 特异度(95%CI) 0.69(0.66~0.72)a 0.68(0.63~0.72)a −0.525 0.600 阳性似然比(95%CI) 2.35(1.93~2.88)a 2.78(1.58~4.90)a − − 阴性似然比(95%CI) 0.43(0.37~0.49)b 0.46(0.32~0.64)a − − 诊断比值比(95%CI) 5.27(4.17~6.65)b 7.45(2.70~20.56)a − − 曲线下的面积 0.7722 0.7326 −0.131 0.896 注:a表示随机效应模型合并;b表示固定效应模型合并;−表示无此项数据。ADC为表观扩散系数;CI为置信区间 表 4 比较ADC平均值与最小值术前预测肝细胞癌MVI的亚组分析
Table 4. Comparing the mean and minimum ADC values for preoperative quantitative prediction of microvascular invasion in hepatocellular carcinoma of subgroup analysis
项目 文献数
(篇)合并灵敏度(95%CI) I2值 Z值 P值 合并特异度(95%CI) I2值 Z值 P值 ADCmin 4 发表年份 −0.775 0.439 −1.549 0.121 ≥2019 2 0.75(0.60~0.86) 30.9% 0.91(0.82~0.96) 5.6% <2019 2 0.63(0.57~0.69) 0 0.63(0.57~0.68) 0 是否采用盲法 −1.549 0.121 −0.775 0.439 是 2 0.63(0.56~0.69) 0 0.71(0.62~0.78) 90.8% 不清楚 2 0.70(0.60~0.79) 58.2% 0.66(0.61~0.71) 94.1% ADCmean 11 MVI(+/−)病灶数的比值 −2.670 0.008 −1.332 0.183 ≥0.6 7 0.79(0.74~0.83) 21.6% 0.64(0.58~0.69) 65.5% <0.6 4 0.62(0.54~0.69) 0 0.73(0.69~0.77) 59.6% 磁场强度 −0.763 0.446 −0.095 0.924 3.0 T 7 0.76(0.69~0.81) 44.7% 0.70(0.65~0.75) 39.6% 1.5 T 4 0.73(0.68~0.77) 79.8% 0.68(0.64~0.73) 86.3% b值数≥2且b值≥800 −1.903 0.057 −0.712 0.476 是 9 0.77(0.73~0.81) 31.5% 0.66(0.62~0.71) 69.7% 否 2 0.59(0.49~0.69) 26.1% 0.73(0.68~0.78) 27.8% 注:ADC为表观扩散系数;MVI为微血管侵犯;ADCmin为ADC最小值;ADCmean为ADC平均值;CI为置信区间 -
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