Accuracy Of Dynamic Contrast-Enhanced Magnetic Resonance Imaging In The Diagnosis Of Prostate Cancer: Systematic Review And Meta-analysis

Objective The goals of this diagnostic meta-analysis were to assess the effectiveness of dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI)in patients with prostate carcinoma(PCa)and to explore the risk profiles with the highest benefit.Methods PubMed,PubMed,Cochrane Library,Cochrane Central Register of Controlled Trials(CENTRAL)and other electronic databases were systematically searched for articles.All studies were retrieved in September 2016.Studies were chosen based on inclusion and exclusion criteria,and study quality was reviewed using the QUADAS-2 criteria.RevMan5 and SAS 9.3 were used to conduct the meta-analysis.A summary receiver operating characteristic(SROC)curve was constructed.Patient-based and biopsy-based pooled weighted estimates of the sensitivity(SEN),specificity(SPE),diagnostic odds radio(OR),and 95% confidence intervals(CIs)were calculated.We performed direct and indirect comparisons of DCE and DCE-MRI with or without other methods of imaging,Results A total of 26 articles(including 2070 patients and 10857 prostatic regions)met the inclusion criteria for the analysis.The whole region pooled estimates sensitivity was 0.55(95% CI 0.42-0.57),with a specificity of 0.89(95% CI 0.84-0.92).The peripheral zone pooled estimates sensitivity was 0.55(95% CI 0.41-0.67),with a specificity of 0.87(95% CI 0.73-0.95).In a direct comparison with DWI,DCE had a relatively lower SEN value on the whole region and peripheral zone.Notable publication bias was detected.Conclusion DCE-MRI had relatively high SPE in detecting PCa but relatively low SEN as a complementary functional method.DCE-MRI might help clinicians exclude cases of normal tissue and serve as an adjunct to conventional imaging when seeking to identify tumor foci in patients with PCa.