Date Published: June 18, 2016
Publisher: Springer US
Author(s): Jin Guo, Youngkwon Seo, Shuo Ren, Sunwoo Hong, Dongki Lee, Soyoun Kim, Yuanyuan Jiang.
The purpose of this study was to directly (head-to-head) compare the per-lesion diagnostic performance of contrast-enhanced computed tomography (CT) (also referred to as CT hereafter) and gadoxetic acid disodium (Gd-EOB-DTPA)-enhanced magnetic resonance (MR) imaging (also referred to as MRI hereafter) for the detection of hepatocellular carcinoma (HCC). Studies reporting direct per-lesion comparison data of contrast-enhanced multidetector CT and Gd-EOB-DTPA-enhanced MR imaging that were published between January 2000 and January 2015 were analyzed. The data of each study were extracted. Systematic review, paired meta-analysis, and subgroup analysis were performed. Twelve studies including 627 patients and 793 HCC lesions were analyzed. The sensitivity estimates of MRI and CT were, respectively, 0.86 (95% CI 0.76–0.93) and 0.70 (95% CI 0.58–0.80), with significant difference (P < 0.05). The sensitivity estimates were both 0.94 (95% CI 0.92–0.96) (Chi-square 4.84, degrees of freedom = 1, P > 0.05). In all subgroups, Gd-EOB-DTPA-enhanced MR imaging was more sensitive than multidetector CT for the detection of HCC, and specificity estimates of both tests maintained at a similarly high level in all conditions: sensitivity estimates of both tests were reduced in studies where patients were diagnosed with HCC solely by liver explant or in those where HCC lesions were small (≤2 cm, especially when ≤1 cm). But in all situations, sensitivities of MRI were higher than those of CT with or without significance. Gd-EOB-DTPA-enhanced MR imaging showed better per-lesion diagnostic performance than multidetector CT for the diagnosis of HCC in patients with cirrhosis and in small hepatic lesions.
This meta-analysis was performed in accordance with the recommendations outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement (PRISMA) . There is no review protocol registered for this research.
Although MR imaging and CT were compared in previous studies, such comparisons either did not confine to MR imaging with solely Gd-EOB-DTPA as contrast agent, and included merely a limited number of head-to-head comparison studies. Direct comparison is the preferable method to analyze differences between two techniques, as it reduces heterogeneity and provides evidence at a higher level . In addition, per-lesion analysis provides additional information to that provided by per-patient analysis, such as the location of lesions. By searching literature thoroughly focusing on studies of head-to-head comparison and by applying a strictly designed inclusion criteria, we collected twelve studies of quite a considerable number of patients and lesions to perform this meta-analysis, aiming to add to the evidence for the feasible application of either imaging scan to detect HCC.
MR imaging with Gd-EOB-DTPA is superior to multidetector CT for the diagnosis of HCC, showing higher sensitivity in more demanding situations such as severe cirrhosis or lesions measuring smaller than 1 cm.