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European Radiology

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16.07.2018 | Magnetic Resonance

Chemical shift imaging for evaluation of adrenal masses: a systematic review and meta-analysis

verfasst von: Ivan Platzek, Dominik Sieron, Verena Plodeck, Angelika Borkowetz, Michael Laniado, Ralf-Thorsten Hoffmann

Erschienen in: European Radiology | Ausgabe 2/2019

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Abstract

Objectives

To perform a systematic review and meta-analysis of published data to evaluate the utility of chemical shift imaging (CSI) for differentiating between adrenal adenomas and non-adenomas.

Methods

A systematic search of the MEDLINE, Web of Science Core Collection, EMBASE and Cochrane Central Register of Controlled Trials electronic databases was performed. The methodological quality of the included studies was assessed by using the QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies) tool. A bivariate random effect model was used to determine summary and subgroup sensitivity and specificity and calculate summary receiver operating characteristic curves (SROC).

Results

Eighteen studies with 1138 patients and 1280 lesions (859 adenomas, 421 non-adenomas) in total were included. In addition to summary analysis, quantitative analyses of the adrenal signal intensity index (SII, 978 lesions, 14 studies), adrenal-to-spleen ratio (ASR; 394 lesions, 7 studies) and visual analysis (560 lesions, 5 studies) were performed. The resultant data showed considerable heterogeneity (inconsistency index I² of 94%, based on the diagnostic odds ratio, DOR). The pooled sensitivity of CSI for adenoma was 0.94 [95% confidence interval (CI) 0.88–0.97] and pooled specificity was 0.95 (95% CI 0.89–0.97). The area (AUC) under the SROC curve was 0.98 (95% CI 0.96–0.99). The corresponding AUCs were 0.98, 0.99 and 0.95 for SII, ASR and visual evaluation, respectively.

Conclusion

CSI has high sensitivity, specificity and accuracy for adrenal adenoma. Diagnostic performance does not improve when quantitative indices are used.

Key Points

• Inclusion of CSI in abdominal MRI protocols provides an effective solution for classifying adrenal masses discovered on MR exams

• Visual evaluation of adrenal CSI is sufficient; use of quantitative indices does not improve diagnostic accuracy

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Titel: Chemical shift imaging for evaluation of adrenal masses: a systematic review and meta-analysis
verfasst von: Ivan Platzek
Dominik Sieron
Verena Plodeck
Angelika Borkowetz
Michael Laniado
Ralf-Thorsten Hoffmann
Publikationsdatum: 16.07.2018
Verlag: Springer Berlin Heidelberg
Erschienen in: European Radiology / Ausgabe 2/2019
Print ISSN: 0938-7994
Elektronische ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-018-5626-5

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Chemical shift imaging for evaluation of adrenal masses: a systematic review and meta-analysis