Preoperative Evaluation of the Histological Grade of Hepatocellular Carcinoma with Diffusion-Weighted Imaging: A Meta-Analysis

Abstract

ObjectiveTo evaluate the diagnostic performance of diffusion-weighted imaging (DWI) in the preoperative prediction of the histological grade of hepatocellular carcinoma (HCC).Materials and MethodsA comprehensive literature search was performed in several authoritative databases to identify relevant articles. QUADAS-2 was used to assess the quality of included studies. Data were extracted to calculate the pooled sensitivity, specificity, positive likelihood ratio (PLR) and negative likelihood ratio (NLR). Summary receiver operating characteristic (SROC) curves were derived and areas under the SROC curve (AUC) were computed to indicate the diagnostic accuracy. Heterogeneity test, meta-regression analysis and sensitivity analysis were performed to identify factors and studies contributed to the heterogeneity.ResultsA total of 11 studies with 912 HCCs were included in this meta-analysis. The pooled sensitivity, specificity, PLR and NLR with corresponding 95% confidence intervals (CI) were 0.54(0.47–0.61), 0.90(0.87–0.93), 4.88(2.99–7.97) and 0.46(0.27–0.77) for the prediction of well-differentiated HCC (w-HCC), 0.84(0.78–0.89), 0.48(0.43–0.52), 2.29(1.43–3.69) and 0.30(0.22–0.41) for the prediction of poorly-differentiated HCC (p-HCC). The AUC were 0.9311 and 0.8513 in predicting w-HCC and p-HCC, respectively. Results were further evaluated according to the method of image interpretation. Significant heterogeneity was observed.ConclusionDWI had excellent and moderately high diagnostic accuracy for the detection of w-HCC and p-HCC, respectively. Nonetheless, further studies in larger populations and an optimized image acquisition and interpretation are required before DWI-derived parameters can be used as a useful image biomarker for the prediction of the histological grade of HCC.

MR elastography of hepatocellular carcinoma: Correlation of tumor stiffness with histopathology features—Preliminary findings

“…Choi et al have shown that HCCs with atypical enhancement pattern and iso-to-hyperintensity on contrast-enhanced MRI were associated with lower tumor grade and better prognosis after surgical resection [16]. Moreover, a recent meta-analysis showed that diffusion-weighted imaging (DWI) has a high diagnostic accuracy in the preoperative prediction of well and poorly differentiated HCC (AUC = 0.93 and 0.85, respectively) [20]. Venkatesh et al have shown that MRE is feasible for measuring liver tumor stiffness (kPa) and is more accurate than diffusion-weighted imaging (DWI) for differentiating benign and malignant focal liver lesions [23,24].…”

“…As such, imaging biomarkers may provide important surrogate HCC tumor biologic, pathologic and ultimately prognostic information for patient stratification in clinical trials and clinical practice [14]. Various imaging features by CT, MRI and PET have been proposed as imaging biomarkers for HCC but none have been translated into routine clinical practice or clinical trials for HCC [15–20]. Magnetic resonance elastography (MRE) is a noninvasive MRI based technique for quantitatively assessing the mechanical properties of tissues and has been used clinically most extensively in the liver as a quantitative tool for diagnosing and staging liver fibrosis [21,22].…”

Multiparametric MR Imaging in Abdominal Malignancies

“…20 Most commonly, HCC shows restriction of water diffusion, paralleling degree of cellularity and dedifferentiation. Furthermore, a recent meta-analysis concluded that DWI had excellent and moderately high diagnostic accuracy for the prediction of well-differentiated versus poorly differentiated HCC, 21 although overlap remains between different histologic grades. 22 Recently, IVIM-derived D values of HCC showed significantly better diagnostic performance than ADC values in differentiating high-grade from low-grade HCC.…”

Diagnostic accuracy of quantitative diffusion parameters in the pathological grading of hepatocellular carcinoma: A meta‐analysis

“…A meta‐analysis of using DWI to assess the histological grade of HCC was performed by Chen et al in 2015, and the authors concluded that the pooled sensitivity and specificity of DWI were 54% and 90% for discriminating well‐differentiated HCC and 84% and 48% for discriminating poorly differentiated HCC, respectively. However, seven of the 11 included DWI studies were quantitative and the others were qualitative, which can inevitably cause between‐study heterogeneity and affect the accuracy of the research results.…”