Meta-Analysis
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Meta-Anal. Aug 26, 2016; 4(4): 95-104
Published online Aug 26, 2016. doi: 10.13105/wjma.v4.i4.95
Gadoxetic acid-enhanced magnetic resonance imaging for the detection of small hepatocellular carcinoma (≤ 2.0 cm) in patients with chronic liver disease: A meta-analysis
Yan Shan, Jian Gao, Meng-Su Zeng, Jiang Lin, Peng-Ju Xu
Yan Shan, Meng-Su Zeng, Jiang Lin, Peng-Ju Xu, Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Medical Imaging, Shanghai 200032, China
Jian Gao, Center of Clinical Epidemiology and Evidence-based Medicine, Fudan University, Shanghai 200032, China
Author contributions: Shan Y, Gao J and Xu PJ concepted/designed this study; all authors contributed to data acquisition or data analysis/interpretation; Shan Y, Gao J and Xu PJ drafting or revision this manuscript for important intellectual content; Gao J contributed to statistical analysis; Shan Y and Gao J contributed equally to this work.
Conflict-of-interest statement: The authors declare that there is no conflict of interest related to this study.
Data sharing statement: Supplementary files provide detailed description of 10 studies included in the meta-analysis.
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: Peng-Ju Xu, MD, Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Medical Imaging, 180 Fenglin Road, Shanghai 200032, China. xpjbfc@163.com
Telephone: +86-21-64041990 Fax: +86-21-64038472
Received: March 11, 2016
Peer-review started: March 14, 2016
First decision: April 14, 2016
Revised: April 28, 2016
Accepted: June 14, 2016
Article in press: June 16, 2016
Published online: August 26, 2016
Processing time: 167 Days and 22.1 Hours
Abstract
AIM

To perform a meta-analysis assessing the value of gadoxetic acid-enhanced magnetic resonance imaging (Gd-EOB-MRI) in detecting small hepatocellular carcinoma (HCC) (≤ 2.0 cm) in patients with chronic liver disease.

METHODS

Databases, including MEDLINE and EMBASE, were searched for relevant original articles published from January 2008 to February 2015. Data were extracted, and summary estimates of diagnostic accuracy indexes such as sensitivity, specificity, diagnostic odds ratio, predictive value, and areas under summary receiver operating characteristic curve were obtained using a random-effects model, with further exploration employing meta-regression and subgroup analyses.

RESULTS

In 10 studies evaluating 768 patients, pooled per-lesion sensitivity of Gd-EOB-DTPA was 91% (95%CI: 83%-95%), with a specificity of 95% (95%CI: 87%-98%). Overall positive likelihood ratio was 18.1 (95%CI: 6.6-49.4), for negative likelihood ratio (NLR) of 0.10 (95%CI: 0.05-0.19) and diagnostic odds ratio of 182 (95%CI: 57-581). Subgroup analysis suggested that diagnostic performance of Gd-EOB-MRI for sub-centimeter HCC (≤ 1.0 cm) detection was low, with a sensitivity of 69% (95%CI: 59%-78%). In studies with both Gd-EOB-MRI and diffusion-weighted imaging (DWI) performed, Gd-EOB-MRI/DWI combination was more sensitive than Gd-EOB-DTPA alone, whether for small lesions (86% vs 77%) or sub-centimeter ones (80% vs 56%).

CONCLUSION

A limited number of small studies suggested that Gd-EOB-MRI has good diagnostic performance in the detection of small HCC (≤ 2.0 cm) among patients with chronic liver disease, but relatively lower performance for detection of sub-centimeter HCC (≤ 1.0 cm). Combination of Gd-EOB-MRI and DWI can improve the diagnostic sensitivity of MRI.

Keywords: Liver-specific agent, Gadoxetic acid-enhanced Magnetic resonance imaging, Hepatocellular carcinoma, Meta-analysis

Core tip: Although studies have shown that gadoxetic acid-enhanced magnetic resonance imaging (Gd-EOB-MRI) had good diagnostic performance in detecting hepatocellular carcinoma (HCC), the results about small HCC have been limited thus far by a small number of included patients, especially for subcentimeter lesion (≤ 1.0 cm). Therefore, we performed a systematic review and meta-analysis to obtain updated diagnostic performance values of Gd-EOB-MRI for the detection of small HCC in terms of different size (≤ 2.0 cm vs≤ 1.0 cm), different technique (Gd-EOB-MRI alone vs combined diffusion weighted imaging).