Diagnostic significance of diffusion-weighted MRI in patients with cervical cancer: a meta-analysis

The aim of this meta-analysis is to demonstrate whether diffusion-weighted magnetic resonance imaging (DWI) could assist in the precise diagnosis of cervical cancer or not. Both English and Chinese electronic databases were searched for potential relevant studies followed by a comprehensive literature search without any language restriction. Two reviewers independently assessed the methodological quality of the included trials. Standardized mean difference (SMD) and its corresponding 95 % confidence interval (95 % CI) were calculated in this meta-analysis. We chose Version 12.0 STATA statistical software to analyze our statistical data. Thirteen eligible cohort studies were selected for statistical analysis, including 645 tumor tissues and 504 normal tissues. Combined SMD of apparent diffusion coefficient (ADC) suggested that the ADC value in cervical cancer tissues was significantly lower than that of normal tissue (SMD = 2.80, 95 % CI = 2.64 ~ 2.96, P < 0.001). Subgroup analysis stratified by ethnicity indicated a higher ADC value in the normal tissues compared to the cancer tissues in both the Asian and Caucasian subgroups (Asians: SMD = 2.83, 95 % CI = 2.64 ~ 3.02, P < 0.001; Caucasians: SMD = 2.73, 95 % CI = 2.45 ~ 3.01, P < 0.001, respectively). The results from the subgroup analysis by MRI machine type revealed a statistically significant difference in ADC value between normal cervical tissue and tumor tissues among all of the six MRI machine type subgroups (all P < 0.05). The main finding from our meta-analysis revealed that increased signal intensity on DWI and decreased signal on ADC seem to be useful in the diagnosis of cervical cancer. DWI could therefore be an important imaging tool in potentially identifying patients with cervical cancer.