Eur Radiol DOI 10.1007/s00330-015-3840-y
MAGNETIC RESONANCE
Apparent diffusion coefficient values of diffusion-weighted imaging for distinguishing focal pulmonary lesions and characterizing the subtype of lung cancer: a meta-analysis Guohua Shen 1 & Zhiyun Jia 1 & Houfu Deng 1
Received: 30 November 2014 / Revised: 27 April 2015 / Accepted: 8 May 2015 # European Society of Radiology 2015
Abstract Objectives The potential performance of apparent diffusion coefficient (ADC) values for distinguishing malignant and benign pulmonary lesions, further characterizing the subtype of lung cancer was assessed. Methods PubMed, EMBASE, Cochrane Library, EBSCO, and three Chinese databases were searched to identify eligible studies on diffusion-weighted imaging (DWI) of focal pulmonary lesions. ADC values of malignant and benign lesions were extracted by lesion type and statistically pooled based on a linear mixed model. Further analysis for subtype of lung cancer was also performed. The methodological quality was assessed using the quality assessment of diagnostic accuracy studies tool. Results Thirty-four articles involving 2086 patients were included. Malignant pulmonary lesions have significantly lower ADC values than benign lesions [1.21 (95 % CI, 1.19–1.22) mm2/s vs. 1.76 (95 % CI, 1.72–1.80) mm2/s; P1.0
>1.0
Lesion size (cm)
GE 1.5 T SS-EPI 0,500 Siemens 1.5 T ND ND Siemens 1.5 T
Siemens 3.0 T SE-EPI 0, 400, 1000 GE 1.5 T STIR-EPI 0, 600 GE 1.5 T SS-SE-EPI 0, 500 Siemens 3.0 T STIR-EPI 0,300,500,700,900
GE 1.5 T SE-EPI 0, 250, 300, 400 GE 3.0 T ASSET/SE-EPI 0, 500
Siemens 1.5 T SE-EPI 50, 400, 800 GE 1.5 T STIR-EPI 0, 600
GE 1.5 T STIR-EPI 0, 600 Philips 1.5 T STIR-EPI 0, 500 Siemens 1.5 T SE-EPI 0, 500
DWI parameters
QUADAS score
N#
12
13
12
13
HP
HP
HP
HP
12
11
HP
HP
11
HP
HP+CFU 10
HP
HP+CFU 11
11
11
HP
HP
11
HP
HP+CFU 10
RS
Eur Radiol
71
66
62
2012 China
Gumustas 2012 China
2010 China
2012 China
2008 China
2010 China
2014 China
2014 China
2009 Japan
2014 Japan
Deng
Liu
Li
Wu
Li
Zhang
Wang
Uto
Usuda
189
28
31
113
27
61
115
60
2014 China
Chen
58
2012 China
68.5 (37–87)
64.2±9.35
57.17±8.82 (32–73)
59±9 (26–81)
53.85 (28–75)
58±12 (24–83)
59.45±8.65 (38–85)
58.37 (38–78)
64±21 (41–83)
51.5±12.5 (20–73)
ND
57.3 (25–80)
(41–68)
P
P
P
P
ND
ND
ND
P
ND
P
ND
124/65 P
22/6
17/14
67/46
13/14
42/19
71/44
38/24
49/17
46/25
41/19
39/19
189
28
31
113
20
61
115
66
67
71
60
58
AC 97,SCC 36, LCC 3, SCLC 3, ASC 1, NET 1, SC 2, metastasis 17
AC 11, SCLC 3, SCC 1, LCC 1, NSCLC 2
AC 12, SCC 12, SCLC 7
AC 32, SCC 25, ASC 4, SCLC 14, metastasis 2
Central lung cancer 13, solitary peripheral lung cancer 24, alveolar carcinoma 1 peripheral lung cancer 12
SCC 44, AC 43, SCLC 27, LCC 1
SCC 15, AC 13, BAC 5, SCC 9, ASC 2, SC 1, Poorly differentiated carcinoma 2, Metastasis 7
SCC 5, AC 13, LCC 2, others 22, SCLC 6
SCC 14, AC 18, SCLC 4, others 8, metastasis 3
SCC 14, AC 37, SCLC 9
SCC 14, AC 29, SCLC 15
Year Nation Patients Mean age in Gender Study Lesions Malignant lesions years (range) (M/F) design
Chen
Study
Table 1 (continued)
Inflammation 6, cryptogenic organizing pneumonia 1, sarcoidosis 1, fungal infection 1,nontubeculous mycobacterial infection 1 ND
Obstructive pulmonary consolidations 31
inflammation 31, others 5
Tuberculoma 5, hamartoma 3
Lobar pneumonia 13, tuberculosis 4, abscess 2, inflammation 4
Tuberculoma 12, inflammatory pseudotumor 4, lung abscess 3, hamartoma 1, sclerosing hemangioma 1, colored mold 1, others 2 Chronic inflammation 9, Sarcoidosis 3, Acute bacteriel pneumonia 2, tuberculosis pneumonia 2, Romatoid nodule 1, Granuloma 1, Hamartoma 1 Tuberculoma 3, bacterial pneumonia 2, hamartoma 1, sclerosing haemangioma 1, inflammatory pseudotumour 1, schwannoma 1, sarcoidosis 1, inflammation 1, lung abscess 1 NO
NO
NO
Benign lesions
GE 1.5 T SS-EPI 0,500
≥1.4
0.5-10
Siemens 1.5 T SS-EPI 0,800
1.4-12.2 GE 3.0 T SE-EPI 0,500 1.9-6.8 Philips 3.0 T STIR-EPI 0, 500 ND GE 1.5 T SS-EPI 300,500,800 ND Siemens 3.0 T SS-SE-EPI 0, 1000 ≥1.5 Siemens 1.5 T RT-IVIM 12 b values 0,5,10,15,20,25, 80,150,300,500,800 >1.0 GE 1.5 T SE-EPI 0,1000
Philips 1.5 T SS-SE-EPI 0,1000
STIR-SS-EPI 100,500,800 Siemens 3.0 T SE-EPI 50,1000 Siemens 3.0 T SE-EPI 50,1000 Siemens 1.5 T SE-EPI 300,500,800
DWI parameters
>1.0
≥1.5
>2
>2
Lesion size (cm)
11
HP
11
13
HP+CFU 12
HP+CFU 10
HP+CFU 11
HP
HP+CFU 10
HP+CFU 12
HP
HP+CFU 12
HP+CFU 13
HP+CFU 10
14
QUADAS score
HP
RS
Eur Radiol
2011 China
2007 Japan
2011 Egypt
2010 Japan
2014 Japan
Li
Matoba
Razek
Koyama
Koyama
66.8 (42–82)
65.3 (45–81)
57 (35–77)
68 (55–76)
58.3±9.6 (36–85)
63.6 (42–85)
30/19
14/18
ND
21/9
69/47
46/3
ND
ND
P
P
ND
P
49
33
31
30
120
49
34
Consolidation 27
AC 30, SCC 14, NET 5, SCLC 7
AC 33
AC 7, SCC 11, LCC 6, SCLC 7
NO
NO
NO
SCC 31, AC 31, BAC 5, SCLC 19, Inflammation 4, tuberculoma 4, sarcoidosis 4, hamartoma 2, ASC 2, SC 2, poor differentiated sclerosing hemangioma 2, carcinoma 2, LCC 1, metastasis 4 organizing pneumonia 1, inflammatory pseudotumor 1, schwannoma 1, neurofibroma 1 SCC 13, AC 11, LCC 3, SCLC 3 NO
SCC 32, SCLC 9, AC 8
AC 16, SCC 12, mediastinal tumor 2 Chronic inflammation 4
NO
Benign lesions
1.1-6.9
0.5-6.9
ND
>2.0
>1.5
>2.0
≥1.0
ND
Lesion size (cm)
Siemens 1.5 T SS-SE-EPI 68.46, 577.05 Siemens 1.5 T SE-EPI 0,300,600 Philips 1.5 T SS-STIR-SE-EPI 0,1000 Philips 1.5 T SS-STIR-SE-EPI 0,1000
Siemens 1.5 T SS-EPI 0,800 Philips 1.5 T STIR-EPI 0-500-1000 Philips 1.5 T SS-SE-EPI 0,1000 GE 3.0 T SE-EPI 0,200,500,800,1000
DWI parameters
11
HP
11
14
13
13
HP
HP
HP
HP
HP+CFU 10
14
13
HP
HP
QUADAS score
RS
ND no documented, NO no benign lesions included, N# this article is not a diagnostic study, not assessed by QUADAS tool, SCC squamous cell carcinoma, AC adenocarcinoma, SCLC small cell lung cancer, LCC large cell carcinoma, SC sarcomatoid carcinoma, BAC bronchioloalveolar carcinoma, CCC clear cell carcinoma, ASC adenosquamous carcinoma
49
32
31
30
116
49
R
25/9
2009 Turkey
59 (47–73)
AC 42, SCC 19, LCC 1, SC 1
Baysal
34
319
2011 Italy
P
41/22
Tondo
68 (38–81)
2011 Japan
Usuda
63
Year Nation Patients Mean age in Gender Study Lesions Malignant lesions years (range) (M/F) design
Study
Table 1 (continued)
Eur Radiol
Eur Radiol Table 2
Numbers and ADC measurements of focal pulmonary lesions
Lesion type
Number
Pooled ADC
SE
95 % CI
p value
Benign lesions Malignant lesions SCLC NSCLC SCC AC LCC
521 1331 202 736 296 372 18
1.76 1.21 1.25 1.35 1.31 1.34 1.29
0.02 0.01 0.02 0.01 0.02 0.02 0.10
1.72–1.80 1.19–1.22 1.21–1.29 1.33–1.37 1.27–1.35 1.31–1.37 1.11–1.50
MAGNETIC RESONANCE
Apparent diffusion coefficient values of diffusion-weighted imaging for distinguishing focal pulmonary lesions and characterizing the subtype of lung cancer: a meta-analysis Guohua Shen 1 & Zhiyun Jia 1 & Houfu Deng 1
Received: 30 November 2014 / Revised: 27 April 2015 / Accepted: 8 May 2015 # European Society of Radiology 2015
Abstract Objectives The potential performance of apparent diffusion coefficient (ADC) values for distinguishing malignant and benign pulmonary lesions, further characterizing the subtype of lung cancer was assessed. Methods PubMed, EMBASE, Cochrane Library, EBSCO, and three Chinese databases were searched to identify eligible studies on diffusion-weighted imaging (DWI) of focal pulmonary lesions. ADC values of malignant and benign lesions were extracted by lesion type and statistically pooled based on a linear mixed model. Further analysis for subtype of lung cancer was also performed. The methodological quality was assessed using the quality assessment of diagnostic accuracy studies tool. Results Thirty-four articles involving 2086 patients were included. Malignant pulmonary lesions have significantly lower ADC values than benign lesions [1.21 (95 % CI, 1.19–1.22) mm2/s vs. 1.76 (95 % CI, 1.72–1.80) mm2/s; P1.0
>1.0
Lesion size (cm)
GE 1.5 T SS-EPI 0,500 Siemens 1.5 T ND ND Siemens 1.5 T
Siemens 3.0 T SE-EPI 0, 400, 1000 GE 1.5 T STIR-EPI 0, 600 GE 1.5 T SS-SE-EPI 0, 500 Siemens 3.0 T STIR-EPI 0,300,500,700,900
GE 1.5 T SE-EPI 0, 250, 300, 400 GE 3.0 T ASSET/SE-EPI 0, 500
Siemens 1.5 T SE-EPI 50, 400, 800 GE 1.5 T STIR-EPI 0, 600
GE 1.5 T STIR-EPI 0, 600 Philips 1.5 T STIR-EPI 0, 500 Siemens 1.5 T SE-EPI 0, 500
DWI parameters
QUADAS score
N#
12
13
12
13
HP
HP
HP
HP
12
11
HP
HP
11
HP
HP+CFU 10
HP
HP+CFU 11
11
11
HP
HP
11
HP
HP+CFU 10
RS
Eur Radiol
71
66
62
2012 China
Gumustas 2012 China
2010 China
2012 China
2008 China
2010 China
2014 China
2014 China
2009 Japan
2014 Japan
Deng
Liu
Li
Wu
Li
Zhang
Wang
Uto
Usuda
189
28
31
113
27
61
115
60
2014 China
Chen
58
2012 China
68.5 (37–87)
64.2±9.35
57.17±8.82 (32–73)
59±9 (26–81)
53.85 (28–75)
58±12 (24–83)
59.45±8.65 (38–85)
58.37 (38–78)
64±21 (41–83)
51.5±12.5 (20–73)
ND
57.3 (25–80)
(41–68)
P
P
P
P
ND
ND
ND
P
ND
P
ND
124/65 P
22/6
17/14
67/46
13/14
42/19
71/44
38/24
49/17
46/25
41/19
39/19
189
28
31
113
20
61
115
66
67
71
60
58
AC 97,SCC 36, LCC 3, SCLC 3, ASC 1, NET 1, SC 2, metastasis 17
AC 11, SCLC 3, SCC 1, LCC 1, NSCLC 2
AC 12, SCC 12, SCLC 7
AC 32, SCC 25, ASC 4, SCLC 14, metastasis 2
Central lung cancer 13, solitary peripheral lung cancer 24, alveolar carcinoma 1 peripheral lung cancer 12
SCC 44, AC 43, SCLC 27, LCC 1
SCC 15, AC 13, BAC 5, SCC 9, ASC 2, SC 1, Poorly differentiated carcinoma 2, Metastasis 7
SCC 5, AC 13, LCC 2, others 22, SCLC 6
SCC 14, AC 18, SCLC 4, others 8, metastasis 3
SCC 14, AC 37, SCLC 9
SCC 14, AC 29, SCLC 15
Year Nation Patients Mean age in Gender Study Lesions Malignant lesions years (range) (M/F) design
Chen
Study
Table 1 (continued)
Inflammation 6, cryptogenic organizing pneumonia 1, sarcoidosis 1, fungal infection 1,nontubeculous mycobacterial infection 1 ND
Obstructive pulmonary consolidations 31
inflammation 31, others 5
Tuberculoma 5, hamartoma 3
Lobar pneumonia 13, tuberculosis 4, abscess 2, inflammation 4
Tuberculoma 12, inflammatory pseudotumor 4, lung abscess 3, hamartoma 1, sclerosing hemangioma 1, colored mold 1, others 2 Chronic inflammation 9, Sarcoidosis 3, Acute bacteriel pneumonia 2, tuberculosis pneumonia 2, Romatoid nodule 1, Granuloma 1, Hamartoma 1 Tuberculoma 3, bacterial pneumonia 2, hamartoma 1, sclerosing haemangioma 1, inflammatory pseudotumour 1, schwannoma 1, sarcoidosis 1, inflammation 1, lung abscess 1 NO
NO
NO
Benign lesions
GE 1.5 T SS-EPI 0,500
≥1.4
0.5-10
Siemens 1.5 T SS-EPI 0,800
1.4-12.2 GE 3.0 T SE-EPI 0,500 1.9-6.8 Philips 3.0 T STIR-EPI 0, 500 ND GE 1.5 T SS-EPI 300,500,800 ND Siemens 3.0 T SS-SE-EPI 0, 1000 ≥1.5 Siemens 1.5 T RT-IVIM 12 b values 0,5,10,15,20,25, 80,150,300,500,800 >1.0 GE 1.5 T SE-EPI 0,1000
Philips 1.5 T SS-SE-EPI 0,1000
STIR-SS-EPI 100,500,800 Siemens 3.0 T SE-EPI 50,1000 Siemens 3.0 T SE-EPI 50,1000 Siemens 1.5 T SE-EPI 300,500,800
DWI parameters
>1.0
≥1.5
>2
>2
Lesion size (cm)
11
HP
11
13
HP+CFU 12
HP+CFU 10
HP+CFU 11
HP
HP+CFU 10
HP+CFU 12
HP
HP+CFU 12
HP+CFU 13
HP+CFU 10
14
QUADAS score
HP
RS
Eur Radiol
2011 China
2007 Japan
2011 Egypt
2010 Japan
2014 Japan
Li
Matoba
Razek
Koyama
Koyama
66.8 (42–82)
65.3 (45–81)
57 (35–77)
68 (55–76)
58.3±9.6 (36–85)
63.6 (42–85)
30/19
14/18
ND
21/9
69/47
46/3
ND
ND
P
P
ND
P
49
33
31
30
120
49
34
Consolidation 27
AC 30, SCC 14, NET 5, SCLC 7
AC 33
AC 7, SCC 11, LCC 6, SCLC 7
NO
NO
NO
SCC 31, AC 31, BAC 5, SCLC 19, Inflammation 4, tuberculoma 4, sarcoidosis 4, hamartoma 2, ASC 2, SC 2, poor differentiated sclerosing hemangioma 2, carcinoma 2, LCC 1, metastasis 4 organizing pneumonia 1, inflammatory pseudotumor 1, schwannoma 1, neurofibroma 1 SCC 13, AC 11, LCC 3, SCLC 3 NO
SCC 32, SCLC 9, AC 8
AC 16, SCC 12, mediastinal tumor 2 Chronic inflammation 4
NO
Benign lesions
1.1-6.9
0.5-6.9
ND
>2.0
>1.5
>2.0
≥1.0
ND
Lesion size (cm)
Siemens 1.5 T SS-SE-EPI 68.46, 577.05 Siemens 1.5 T SE-EPI 0,300,600 Philips 1.5 T SS-STIR-SE-EPI 0,1000 Philips 1.5 T SS-STIR-SE-EPI 0,1000
Siemens 1.5 T SS-EPI 0,800 Philips 1.5 T STIR-EPI 0-500-1000 Philips 1.5 T SS-SE-EPI 0,1000 GE 3.0 T SE-EPI 0,200,500,800,1000
DWI parameters
11
HP
11
14
13
13
HP
HP
HP
HP
HP+CFU 10
14
13
HP
HP
QUADAS score
RS
ND no documented, NO no benign lesions included, N# this article is not a diagnostic study, not assessed by QUADAS tool, SCC squamous cell carcinoma, AC adenocarcinoma, SCLC small cell lung cancer, LCC large cell carcinoma, SC sarcomatoid carcinoma, BAC bronchioloalveolar carcinoma, CCC clear cell carcinoma, ASC adenosquamous carcinoma
49
32
31
30
116
49
R
25/9
2009 Turkey
59 (47–73)
AC 42, SCC 19, LCC 1, SC 1
Baysal
34
319
2011 Italy
P
41/22
Tondo
68 (38–81)
2011 Japan
Usuda
63
Year Nation Patients Mean age in Gender Study Lesions Malignant lesions years (range) (M/F) design
Study
Table 1 (continued)
Eur Radiol
Eur Radiol Table 2
Numbers and ADC measurements of focal pulmonary lesions
Lesion type
Number
Pooled ADC
SE
95 % CI
p value
Benign lesions Malignant lesions SCLC NSCLC SCC AC LCC
521 1331 202 736 296 372 18
1.76 1.21 1.25 1.35 1.31 1.34 1.29
0.02 0.01 0.02 0.01 0.02 0.02 0.10
1.72–1.80 1.19–1.22 1.21–1.29 1.33–1.37 1.27–1.35 1.31–1.37 1.11–1.50
