Accuracy of Various Forms of Contrast-Enhanced MRI for Diagnosing Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis

Abstract

BackgroundContrast-enhanced MRI can be used to identify patients with hepatocellular carcinoma (HCC). However, studies around the world have found differing diagnostic accuracies for the technique. Hence, we designed this meta-analysis to assess the accuracy of contrast-enhanced MRI for HCC diagnosis.MethodsWe conducted a systematic search for all studies reporting the diagnostic accuracy of contrast-enhanced MRI for HCC in the databases of MEDLINE, EMBASE, Cochrane Library, Web of Science, SCOPUS, ScienceDirect, and Google Scholar from inception until January 2021. We used the “Midas” package from the STATA software to perform the meta-analysis.ResultsOur study was based on 21 publications with 5,361 patients. The pooled HCC diagnosis sensitivity and specificity were 75% (95% CI, 70%–80%) and 90% (95% CI, 88%–92%), respectively, for gadoxetic acid-enhanced MRI; and they were 70% (95% CI, 57%–81%) and 94% (95% CI, 85%–97%), respectively, for MRI with extracellular contrast agents (ECA-MRI). We found significant heterogeneity with a significant chi-square test and an I2 statistic >75%. We also found significant publication bias as per Deeks’ test results and funnel plot.ConclusionWe found that both types of contrast-enhanced MRI are accurate diagnostic and surveillance tools for HCC and offer high sensitivity and specificity. Further studies on different ethnic populations are required to strengthen our findings.

Current Imaging Diagnosis of Hepatocellular Carcinoma

“…MRI is an excellent modality for lesion detection and characterization thanks to its higher contrast resolution and ability to assess more tissue properties than sole vascularization. According to a recent meta-analysis, the pooled sensitivity and specificity for HCC diagnosis were 70% and 94%, respectively, regardless of tumor size [ 122 ]. However, sensitivity is greater for lesions >2 cm (approaching 100%) but drops to 58.3–64.6% for lesions smaller than 2 cm [ 123 , 124 , 125 ], and it is even lower for sub-centimetre lesions.…”

“…A small residual tumor can escape detection in this early stage, though growth on subsequent follow-up imaging, or the presence of “wash-out”, should raise suspicion for viable malignancy [ 213 ]. Although dynamic MDCT is the established method for following patients after thermal ablation, due to its wider availability, MRI might offer superior diagnostic accuracy and sensitivity for detection of recurrent HCC, especially with the use of diffusion-weighted images or liver-specific contrast media [ 122 , 214 ]. Few studies with small sample sizes have evaluated the role of CTLP in exploring the hemodynamic changes of HCC nodules after RFA [ 112 , 197 , 215 ].…”

Contrast Agents for Hepatocellular Carcinoma Imaging: Value and Progression

“…Meanwhile, controversies still remain regarding the diagnostic efficacy of HCC. Despite that the hepatobiliary agent-enhanced MRI is believed to reach an early diagnosis for HCC that is still in the hypovascular stage ( 94 ), researchers analyzed the clinical trials that use different contrast agents for HCC diagnosis and found no significant difference in the diagnostic efficacy in terms of sensitivity and specificity between the MRI using extracellular agents and hepatobiliary agents ( 95 , 96 ). Imbriaco et al.…”

Glucose-Regulated Protein 78 Targeting ICG and DOX Loaded Hollow Fe3O4 Nanoparticles for Hepatocellular Carcinoma Diagnosis and Therapy

“…43 The sensitivity and specificity of contrast-enhanced MRI for detecting HCC nodules are 70% and 94%, respectively. 44 However, the sensitivity drops to 60% for lesions <2 cm, and it is even lower for lesions <1 cm. 45 In our experiments, all HCC lesions (<1 cm) were detected by SP94-Fe3O4@ICG&DOX nanoparticles, which indicated our nanoparticles enhanced the detection sensitivity and had great potential in clinical diagnosis of HCC.…”