Meta-Analysis
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 14, 2015; 21(14): 4334-4344
Published online Apr 14, 2015. doi: 10.3748/wjg.v21.i14.4334
Superparamagnetic iron oxide-enhanced magnetic resonance imaging for focal hepatic lesions: Systematic review and meta-analysis
You-Wei Li, Zheng-Guang Chen, Ji-Chen Wang, Zong-Ming Zhang
You-Wei Li, Department of Radiology, Beijing Chuiyangliu Hospital Affiliated to School of Medicine, Tsinghua University, Beijing 100022, China
Zheng-Guang Chen, Department of Radiology, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing 100700, China
Ji-Chen Wang, Department of Radiology, Nanjing BenQ Hospital, Nanjing 210036, Jiangsu Province, China
Zong-Ming Zhang, Department of General Surgery, Beijing Electric Power Hospital, Capital Medical University, Beijing 100073, China
Author contributions: Zhang ZM designed the study; Li YW, Chen ZG and Wang JC searched and reviewed the literature; Wang JC provided analytic tools and analyzed the data; Li YW and Chen ZG wrote the paper.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Zong-Ming Zhang, MD, PhD, Professor, Director, Department of General Surgery, Beijing Electric Power Hospital, Capital Medical University, No. 1 Taipingqiaoxili, Fengtai District, Beijing 100073, China. zhangzongming@mail.tsinghua.edu.cn
Telephone: +86-10-63503046 Fax: +86-10-63465865
Received: September 9, 2014
Peer-review started: September 10, 2014
First decision: October 14, 2014
Revised: October 25, 2014
Accepted: November 19, 2014
Article in press: November 19, 2014
Published online: April 14, 2015
Processing time: 217 Days and 19.1 Hours
Abstract

AIM: To evaluate the performance of superparamagnetic iron oxide (SPIO)-enhanced magnetic resonance imaging (MRI) in the detection and characterization of focal hepatic lesions (FHLs).

METHODS: This meta-analysis compared relevant studies that were identified by searching PubMed, EMBASE, and the Cochrane Library databases for articles published between January 1988 and September 2014 and that met the following criteria: (1) SPIO-enhanced MRI was conducted to identify FHLs and data were sufficient for pooled analysis using Meta-DiSc 1.4; (2) hepatocellular carcinomas (HCCs) were differentiated from other FHLs; (3) well-differentiated HCCs (WD-HCCs) were contradistinguished from dysplastic nodules; and (4) WD-HCCs were compared with moderately and poorly differentiated HCCs (MD- and PD-HCCs, respectively).

RESULTS: The data obtained from 15 eligible studies yielded a sensitivity of 85% and a specificity of 78% for differentiating between HCCs and other FHLs. The sensitivity was unchanged and the specificity was increased to 87% when non-HCC malignancies were excluded. Comparative analyses between WD-HCCs and MD- and PD-HCCs from seven studies showed a sensitivity of 98% and a specificity of 50% for the diagnosis of MD- and PD-HCCs, and the area under the summary receiver operating characteristics (sROC) curve was 0.97. A comparison between WD-HCCs and dysplastic nodules revealed a sensitivity of 50% and a specificity of 92% for the diagnosis of WD-HCCs and the area under the sROC curve was 0.80.

CONCLUSION: SPIO-enhanced MRI is useful in differentiating between HCCs and other FHLs.

Keywords: Hepatocellular carcinomas; Magnetic resonance imaging; Meta-analysis; Other lesions; USPIO

Core tip: Relevant studies on the performance of superparamagnetic iron oxide (SPIO)-enhanced magnetic resonance imaging (MRI) in the detection and characterization of focal hepatic lesions were identified by searching PubMed, EMBASE, and the Cochrane Library databases for articles published between January 1988 and September 2014 via a systematic review and meta-analysis. The results show that SPIO-enhanced MRI is useful in differentiating between hepatocellular carcinomas (HCCs) and other focal hepatic lesions. Using hyperintensity on SPIO-enhanced T2*-weighted images as the criterion, the sensitivity for diagnosing advanced HCC was 98%. SPIO-enhanced MRI is a valuable tool for the detection and characterization of focal lesions in cirrhotic liver.