石瑞　王艺婷　王阳　张立超　张进

[摘要] 目的 采用Meta分析方法综合评价磁共振动态增强扫描（dynamic contrast enhanced magnetic，DCE-MRI）联合扩散加权成像（diffusion-weighted imaging，DWI）对乳腺良、恶性病变的鉴别诊断价值。 方法 计算机检索中国学术期刊（网络版）、万方医学数据服务平台、中国生物医学数据库、PubMeb Central-NLM期刊全文库、Cochrane图书馆、Ovid循证医学数据库、Science Direct外文数据库等数据库中2007年1月～2016年10月公开发表的相关文献，按照指定纳入标准筛选文献、提取数据信息，采用Meta分析对提取的数据进行统计学分析。 结果 共纳入文献15篇，纳入病灶910个，文献具有同质性，采用固定效应模型计算出汇总敏感度、特异度分别为92%、88%，汇总ROC曲线下面积为0.96，95%CI（0.94，0.97）。 结论 DCE-MRI联合扩散加权成像对乳腺良恶性病变的诊断具有较高的诊断价值，是一种可广泛用于乳腺影像学检查的精确的、非创伤性的检查方法。

[关键词] 乳腺病变；磁共振动态增强扫描；扩散加权成像；Meta分析

[中图分类号] R455.2 [文献标识码] B [文章编号] 1673-9701（2017）04-0110-06

Meta analysis of differential diagnosis value of benign and malignant breast lesions by dynamic contrast enhanced magnetic combined with diffusion weighted imaging

SHI Rui1 WANG Yiting1 WANG Yang1 ZHANG Lichao1 ZHANG Jin2

1.Department of Medical Imaging， Shanxi Medical University， Taiyuan 030001， China； 2.Shanxi Medical University Second Hospital， Taiyuan 030001， China

[Abstract] Objective To comprehensively evaluate the differential diagnostic value of dynamic contrast enhanced magnetic（DCE-MRI） combined with diffusion-weighted imaging（DWI） in benign and malignant breast lesions by Meta analysis. Methods Relevant literature publically released from January 2007 to October 2016 in Chinese Academic Journals（online version）， Wanfang Medical Data Service Platform， Chinese Biomedical Database， PubMeb Central-NLM Journal， Cochrane Library， Ovid Evidence-based Medicine Database， Science Direct Foreign Language Database and other databases were searched by computer. The literature was screened according to the specified inclusion criteria， and the data information was extracted. Meta-analysis was used to statistically analyze the extracted data. Results A total of 15 articles were included， and 910 lesions were included. The literature was homogeneous， and the fixed effect model was used to calculate the overall sensitivity， specificity was 92% and 88% respectively. The area under the ROC curve was 0.96， 95%CI（0.94， 0.97）. Conclusion DCE-MRI combined with diffusion weighted imaging has a high diagnostic value in the diagnosis of benign and malignant breast lesions. It is an accurate and noninvasive method widely used in breast imaging.

[Key words] Breast lesions； Dynamic contrast enhanced magnetic（DCE-MRI）； Diffusion-weighted imaging （DWI）； Meta analysis

乳腺癌是女性最常見的恶性肿瘤和死亡原因，据统计，2012年全球约有170万例患者及521 900例死亡患者，占女性癌症患者的25%，占死亡病例的15%[1]。早期定性诊断乳腺病变对治疗方案的制定、预后估计、远期生存率估算有至关重要的作用。近年来，磁共振扫描被广泛应用于乳腺病变的诊断，诸多文献针对DWI联合DCE-MRI对乳腺良恶性病变的诊断价值进行了研究，但研究结论不尽相同[2-5]，甚至相反[6]。本研究应用循证医学统计学方法，汇总分析国内外关于DCE-MRI联合DWI诊断乳腺病变的大量文献，以综合定量评价DCE-MRI联合扩散加权成像鉴别乳腺病变的诊断价值。……