Value of intravoxel incoherent motion in detecting and staging liver fibrosis: A meta-analysis
Value of intravoxel incoherent motion in detecting and staging liver fibrosis: A meta-analysis
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体素内不相干运动在肝纤维化检测和分期中的价值：荟萃分析
DOI：
10.3748/wjg.v26.i23.3304
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发表时间：
2020-06-21
影响因子：
4.3
通讯作者：
Song, Bin
中科院分区：
文献类型：
--
作者：
Ye, Zheng;Wei, Yi;Song, Bin
背景肝纤维化是所有慢性肝病的共同病理特征。随着细胞外基质在纤维化肝脏中的积聚，真正的分子水扩散和灌注相关扩散受到限制。体素内非相干运动（IVIM）可以分别获取组织扩散系数和微血管灌注信息，并通过扩散系数反映纤维化的严重程度。目的以组织学为参考标准，探讨IVIM对LF的诊断和分期价值。方法：进行了全面的文献检索，以确定IVIM评估组织学证实的LF诊断准确性的研究。根据组织病理学检查结果，将LF分期分为F0（无纤维化）、F1（门静脉纤维化无隔膜）、F2（门静脉周围纤维化伴少量隔膜）、F3（隔膜纤维化）和F4（肝硬化）。提取数据以计算合并的灵敏度、特异性、阳性和阴性似然比、诊断比值比以及每组的汇总受试者工作特征曲线下面积（AUC）。结果共有12项研究（923例受试者）纳入本荟萃分析，其中5项研究（n = 465）为LF ≥ F1，9项研究（n = 757）为LF ≥ F2，4项研究（n = 413）为LF ≥ F3，6项研究（n = 562）为LF = F4。合并的敏感性和特异性估计为0.78（95%置信区间：0.73-0.82）和0.81（0.74-0.86）对于IVIM检测LF ≥ F1; 0.82（0.79-0.86）和0.80（0.75-0.84）用于F2纤维化分期; F3纤维化分期分别为0.85（0.79-0.90）和0.83（0.77-0.87），检测F4肝硬化分别为0.90（0.84-0.94）和0.75（0.70-0.79）。LF ≥ F1、F2、F3、F4检测的AUC分别为0.862（0.811-0.914）、0.883（0.856-0.909）、0.886（0.865-0.907）和0.899（0.866-0.932）。观察到中度至显著异质性，不一致指数（I2）范围为0%至77.9%。未发现发表偏倚。结论IVIM是一种无创性的检测LF的方法，对LF的诊断和分期有良好的诊断价值。为进一步提高IVIM的临床诊断准确性，需要优化和规范IVIM方案。
BACKGROUND Liver fibrosis (LF) is a common pathological feature of all chronic liver diseases. With the accumulation of extracellular matrix in the fibrotic liver, true molecular water diffusion and perfusion-related diffusion are restricted. Intravoxel incoherent motion (IVIM) can capture the information on tissue diffusivity and microcapillary perfusion separately and reflect the fibrotic severity with diffusion coefficients. AIM To investigate the diagnostic performance of IVIM in detecting and staging LF with histology as a reference standard. METHODS A comprehensive literature search was conducted to identify studies on the diagnostic accuracy of IVIM for assessment of histologically proven LF. The stages of LF were classified as F0 (no fibrosis), F1 (portal fibrosis without septa), F2 (periportal fibrosis with few septa), F3 (septal fibrosis), and F4 (cirrhosis) according to histopathological findings. Data were extracted to calculate the pooled sensitivity, specificity, positive and negative likelihood ratios, and diagnostic odds ratio, as well as the area under the summary receiver operating characteristic curve (AUC) in each group. RESULTS A total of 12 studies with 923 subjects were included in this meta-analysis with 5 studies (n = 465) for LF ≥ F1, 9 studies (n = 757) for LF ≥ F2, 4 studies (n = 413) for LF ≥ F3, and 6 studies (n = 562) for LF = F4. The pooled sensitivity and specificity were estimated to be 0.78 (95% confidence interval: 0.73-0.82) and 0.81 (0.74-0.86) for LF ≥ F1 detection with IVIM; 0.82 (0.79-0.86) and 0.80 (0.75-0.84) for staging F2 fibrosis; 0.85 (0.79-0.90) and 0.83 (0.77-0.87) for staging F3 fibrosis, and 0.90 (0.84-0.94) and 0.75 (0.70-0.79) for detecting F4 cirrhosis, respectively. The AUCs for LF ≥ F1, F2, F3, F4 detection were 0.862 (0.811-0.914), 0.883 (0.856-0.909), 0.886 (0.865-0.907), and 0.899 (0.866-0.932), respectively. Moderate to substantial heterogeneity was observed with inconsistency index (I2) ranging from 0% to 77.9%. No publication bias was detected. CONCLUSION IVIM is a noninvasive tool with good diagnostic performance in detecting and staging LF. Optimized and standardized IVIM protocols are needed to further improve its diagnostic accuracy in clinical practice.