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Review
. 2013 Nov 11;8(11):e79008.
doi: 10.1371/journal.pone.0079008. eCollection 2013.

The correlation between apparent diffusion coefficient and tumor cellularity in patients: a meta-analysis

Lihua Chen  1 , Min Liu, Jing Bao, Yunbao Xia, Jiuquan Zhang, Lin Zhang, Xuequan Huang, Jian Wang
Affiliations
Review

The correlation between apparent diffusion coefficient and tumor cellularity in patients: a meta-analysis

Lihua Chen et al. PLoS One. .

Abstract

Objective: To perform a meta-analysis exploring the correlation between the apparent diffusion coefficient (ADC) and tumor cellularity in patients.

Materials and methods: We searched medical and scientific literature databases for studies discussing the correlation between the ADC and tumor cellularity in patients. Only studies that were published in English or Chinese prior to November 2012 were considered for inclusion. Summary correlation coefficient (r) values were extracted from each study, and 95% confidence intervals (CIs) were calculated. Sensitivity and subgroup analyses were performed to investigate potential heterogeneity.

Results: Of 189 studies, 28 were included in the meta-analysis, comprising 729 patients. The pooled r for all studies was -0.57 (95% CI: -0.62, -0.52), indicating notable heterogeneity (P<0.001). After the sensitivity analysis, two studies were excluded, and the pooled r was -0.61 (95% CI: -0.66, -0.56) and was not significantly heterogeneous (P = 0.127). Regarding tumor type subgroup analysis, there were sufficient data to support a strong negative correlation between the ADC and cellularity for brain tumors. There was no notable evidence of publication bias.

Conclusions: There is a strong negative correlation between the ADC and tumor cellularity in patients, particularly in the brain. However, larger, prospective studies are warranted to validate these findings in other cancer types.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Flowchart of the study selection process.
Figure 2
Figure 2. Methodological quality of the 28 studies.
Figure 3
Figure 3. Forest plots of the summary correlation coefficient (r) with corresponding 95% CIs for the correlation between the ADC value and tumor cellularity in patients from all eligible studies.
Figure 4
Figure 4. Forest plots of the pooled r with corresponding 95% CIs after two studies were excluded following a sensitivity analysis and forest plots of the subgroup analysis based on tumor type.
Figure 5
Figure 5. The pooled r with corresponding 95% CIs for the subgroup analysis based on magnetic field strength, the index of the ADC value, the b value, age, and design.
Figure 6
Figure 6. The funnel plot of the publication bias.
The result is suggestive of an indistinctive small study bias (P = 0.103).
See this image and copyright information in PMC

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