为了确定影响定量成像生物标志物 ADC 和 ADCratio 在前列腺癌 (PCa) 检测中的诊断性能的因素。在 Embase、Medline 和 Web of Science 中进行了系统文献检索，以评估 ADC 值和 ADCratio 对 PCa 诊断的研究，使用相同的患者群体并使用组织病理学参考作为基本事实。根据构建的应急数据表计算汇总敏感性、特异性、汇总 ROC 曲线和 AUC。使用双变量混合效应模型对诊断性能（AUC）进行定量汇总。为了确定影响因素，我们进行了亚组分析、发表偏倚和异质性评估。纳入了 13 项研究，涉及 1038 名患者和 1441 个病变。对于 ADC，汇总敏感性和特异性分别为 80% (95% CI: 74-85%) 和 78% (95% CI: 70-85%)。对于 ADCratio，汇总敏感性和特异性分别为 80%（95% CI：74-84%）和 80%（95% CI：71-87%）。摘要 ROC 分析显示 AUC 分别为 0.86 (95% CI: 0.83-0.89) 和 0.86 (95% CI: 0.83-0.89)。荟萃回归显示两种成像生物标志物之间存在异质性。亚组分析显示，当包括外周和移行区病变时，与 ADC 相比，ADCratio 提高了诊断性能（AUC：分别为 0.87 [95% CI：0.84-0.90] 和 0.82 [95% CI：0.79-0.85]）。 两种 ADC和 ADCratio 成像生物标志物在 PCa 诊断中表现出良好且可比的诊断性能。然而，在诊断移行区癌症方面，ADCratio 显示出比 ADC 更好的诊断性能。在基于 MRI 的 PCa 定量诊断中，成像生物标志物 ADCratio 可用于挑战病变的 MRI 读数。更好地了解定量成像生物标志物的性能可以帮助诊断 MRI 方案，提高 PCa 评估的精度。基于 MRI 扩散加权成像的 ADC 和 ADCratio 在 PCa 评估中具有相当的诊断性能。与 ADC 相比，ADCratio 在评估整个腺体病变时提高了诊断性能。与 ADCratio 相比，ADC 在评估周围区域病变时表现出增强的诊断性能。© 2024。作者，获得欧洲放射学会的独家许可。

To identify factors influencing the diagnostic performance of the quantitative imaging biomarkers ADC and ADCratio in prostate cancer (PCa) detection.A systematic literature search was conducted in Embase, Medline and Web of Science, for studies evaluating ADC values and ADCratio for PCa diagnosis, using the same patient cohorts and using histopathological references as ground truth. Pooled sensitivities, specificities, summary ROC curves and AUCs were calculated from constructed contingency data tables. Diagnostic performance (AUC) was quantitatively pooled using a bivariate mixed effects model. For identifying influencing factors, subgroup analysis, publication bias and heterogeneity assessment were investigated.Thirteen studies, involving 1038 patients and 1441 lesions, were included. For ADC, the pooled sensitivity and specificity was 80% (95% CI: 74-85%) and 78% (95% CI: 70-85%), respectively. For ADCratio pooled sensitivity and specificity was 80% (95% CI: 74-84%) and 80% (95% CI: 71-87%). Summary ROC analysis revealed AUCs of 0.86 (95% CI: 0.83-0.89) and 0.86 (95% CI: 0.83-0.89), respectively. Meta-regression showed heterogeneity between both imaging biomarkers. Subgroup analysis showed that ADCratio improved diagnostic performance in comparison to ADC when including both peripheral and transitional zone lesions (AUC: 0.87 [95% CI: 0.84-0.90] and 0.82 [95% CI: 0.79-0.85], respectively).Both ADC and ADCratio imaging biomarkers showed good and comparable diagnostic performance in PCa diagnosis. However, ADCratio shows better diagnostic performance than ADC in diagnosing transition zone cancers.In quantitative MRI-based PCa diagnosis, the imaging biomarker ADCratio is useful in challenging MRI readings of lesions. Understanding the performance of quantitative imaging biomarkers better can aid diagnostic MRI protocols, enhancing the precision of PCa assessments.MRI diffusion-weighted imaging-based ADC and ADCratio have comparable diagnostic performance in PCa assessment. In contrast to ADC, the ADCratio improves diagnostic performance, when assessing whole gland lesions. Compared to ADCratio, the ADC demonstrates enhanced diagnostic performance when evaluating peripheral zone lesions.© 2024. The Author(s), under exclusive licence to European Society of Radiology.