Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine and Science, Rochester, MN.
Liver Imaging Group, Department of Radiology, University of California San Diego, San Diego, CA.
Hepatology. 2018 Jan;67(1):401-421. doi: 10.1002/hep.29487. Epub 2017 Nov 29.
Multiphasic computed tomography (CT) and magnetic resonance imaging (MRI) are both used for noninvasive diagnosis of hepatocellular carcinoma (HCC) in patients with cirrhosis. To determine if there is a relative diagnostic benefit of one over the other, we synthesized evidence regarding the relative performance of CT, extracellular contrast-enhanced MRI, and gadoxetate-enhanced MRI for diagnosis of HCC in patients with cirrhosis. We also assessed whether liver biopsy versus follow-up with the same versus alternative imaging is best for CT-indeterminate or MRI-indeterminate liver nodules in patients with cirrhosis. We searched multiple databases from inception to April 27, 2016, for studies comparing CT with extracellular contrast-enhanced MRI or gadoxetate-enhanced MRI in adults with cirrhosis and suspected HCC. Two reviewers independently selected studies and extracted data. Of 33 included studies, 19 were comprehensive, while 14 reported sensitivity only. For all tumor sizes, the 19 comprehensive comparisons showed significantly higher sensitivity (0.82 versus 0.66) and lower negative likelihood ratio (0.20 versus 0.37) for MRI over CT. The specificities of MRI versus CT (0.91 versus 0.92) and the positive likelihood ratios (8.8 versus 8.1) were not different. All three modalities performed better for HCCs ≥2 cm. Performance was poor for HCCs <1 cm. No studies examined whether adults with cirrhosis and an indeterminate nodule are best evaluated using biopsy, repeated imaging, or alternative imaging. Concerns about publication bias, inconsistent study results, increased risk of bias, and clinical factors precluded support for exclusive use of either gadoxetate-enhanced or extracellular contrast-enhanced MRI over CT.
CT, extracellular contrast-enhanced MRI, or gadoxetate-enhanced MRI could not be definitively preferred for HCC diagnosis in patients with cirrhosis; in patients with cirrhosis and an indeterminate mass, there were insufficient data comparing biopsy to repeat cross-sectional imaging or alternative imaging. (Hepatology 2018;67:401-421).
在肝硬化患者中，多相计算机断层扫描（CT）和磁共振成像（MRI）均被用于非侵入性诊断肝细胞癌（HCC）。为确定一种检查方法相对于另一种检查方法是否具有相对诊断优势，我们综合评估了 CT、细胞外对比增强 MRI 和钆塞酸增强 MRI 对肝硬化患者 HCC 的诊断性能。我们还评估了在肝硬化患者中，对于 CT 结果不确定或 MRI 结果不确定的肝结节，肝活检与同一种或替代影像学检查随访相比哪种方法最佳。我们从建库至 2016 年 4 月 27 日，在多个数据库中搜索了比较 CT 与细胞外对比增强 MRI 或钆塞酸增强 MRI 在肝硬化伴疑似 HCC 成人中的应用的研究。两位审查员独立选择研究并提取数据。在纳入的 33 项研究中，19 项为全面性研究，14 项仅报告了敏感性。对于所有肿瘤大小，19 项全面比较表明 MRI 的敏感性（0.82 对 0.66）显著高于 CT，而阴性似然比（0.20 对 0.37）更低。MRI 与 CT 的特异性（0.91 对 0.92）和阳性似然比（8.8 对 8.1）无差异。所有三种方法在≥2 cm 的 HCC 中表现更好。对于<1 cm 的 HCC，表现不佳。没有研究检查肝硬化伴不确定结节的成人使用活检、重复影像学检查或替代影像学检查哪种方法最佳。由于存在发表偏倚、研究结果不一致、偏倚风险增加和临床因素的担忧，因此不能明确支持在 HCC 诊断中仅使用钆塞酸增强或细胞外对比增强 MRI 优于 CT。
CT、细胞外对比增强 MRI 或钆塞酸增强 MRI 不能被明确地作为肝硬化患者 HCC 诊断的首选方法；在肝硬化伴不确定肿块的患者中，比较活检与重复横断面成像或替代成像的资料不足。
