Diagnostic performance of dynamic contrast-enhanced magnetic resonance imaging for malignant ovarian tumors: a systematic review and meta-analysis

Abstract

Background Accurate preoperative diagnosis of malignant ovarian tumors (MOTs) is particularly important for selecting the optimal treatment strategy and avoiding overtreatment. Purpose To evaluate the diagnostic efficacy of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) for MOTs. Material and Methods A systematic search was performed in PubMed, Embase, the Cochrane Library, and Web of Science databases to find relevant original articles up to October 2019. The included studies were assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Studies on the diagnosis of MOTs with quantitative or semi-quantitative DCE-MRI were analyzed separately. The bivariate random-effects model was used to assess the diagnostic authenticity. Meta-regression analyses were performed to analyze the potential heterogeneity. Results For semi-quantitative DCE-MRI, the pooled sensitivity, specificity, positive likelihood ratio (LR), negative LR, diagnostic odds ratio (DOR), and the area under the summary receiver operating characteristic curves (AUC) were 85% (95% confidence interval [CI] 0.75–0.92), 85% (95% CI 0.77–0.91), 5.8 (95% CI 3.8–8.8), 0.17 (95% CI 0.10–0.30), 33 (95% CI 18–61), and 0.92 (95% CI 0.89–0.94), respectively. For quantitative DCE-MRI, the pooled sensitivity, specificity, positive LR, negative LR, DOR, and AUC were 88% (95% CI 0.65–0.96), 93% (95% CI 0.78–0.98), 12.3 (95% CI 3.4–43.9), 0.13 (95% CI 0.04–0.45), 91 (95% CI 10–857), and 0.96 (95% CI 0.94–0.98), respectively. Conclusion DCE-MRI has great diagnostic value for MOTs. Semi-quantitative DCE-MRI may be a relatively mature approach; however, quantitative DCE-MRI appears to be more promising than semi-quantitative DCE-MRI.