Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
Hepatol Int. 2020 Dec;14(6):1009-1022. doi: 10.1007/s12072-020-10100-7. Epub 2020 Nov 4.
BACKGROUND/PURPOSE: Conflicting results have been reported between the use of extracellular contrast agent (ECA) and hepatobiliary contrast agent (HBA) when magnetic resonance imaging (MRI) is used for the diagnosis of hepatocellular carcinoma (HCC). Therefore, we aimed to compare the diagnostic performance of MRI using ECA (ECA-MRI) and HBA (HBA-MRI).
Original studies reporting the diagnostic performance of contrast-enhanced MRI for the diagnosis of HCC published between January 2010 and February 2020 were identified in a Pubmed, EMBASE, and Cochrane Library database search. The pooled sensitivity and specificity of ECA-MRI and HBA-MRI were calculated using a bivariate random effects model and compared using a joint-model bivariate meta-regression. Subgroup analyses were performed to compare the diagnostic performance of ECA-MRI and HBA-MRI according to study design, underlying liver disease, lesion size, reference standard, and imaging criteria.
Of the 1760 screened articles, 31 studies were included: 15 studies included 2890 lesions imaged using ECA-MRI and 19 studies included 3893 lesions imaged using HBA-MRI. The pooled sensitivity and specificity were not significantly different between ECA-MRI (sensitivity, 72% [95% confidence interval 65-79%]; specificity 92% [89-95%]) and HBA-MRI (76% [68-83%]; 92% [87-95%], p = 0.72). Subgroup analyses did not find differences in diagnostic performance between ECA-MRI and HBA-MRI according to study design (p ≥ 0.11), underlying disease (p ≥ 0.09), lesion size (≤ 2 cm, p = 0.97), reference standard (p = 0.70), or imaging criteria (p = 0.33).
ECA-MRI showed similar performance to HBA-MRI in the diagnosis of HCC. The contrast agent might be selected with consideration of the advantages of each agent.
背景/目的：磁共振成像（MRI）用于诊断肝细胞癌（HCC）时，使用细胞外对比剂（ECA）和肝胆对比剂（HBA）的结果存在冲突。因此，我们旨在比较使用 ECA（ECA-MRI）和 HBA（HBA-MRI）的 MRI 诊断性能。
在 Pubmed、EMBASE 和 Cochrane Library 数据库中搜索 2010 年 1 月至 2020 年 2 月期间发表的关于对比增强 MRI 诊断 HCC 的原始研究。使用双变量随机效应模型计算 ECA-MRI 和 HBA-MRI 的汇总敏感性和特异性，并使用联合模型双变量荟萃回归进行比较。根据研究设计、潜在肝病、病变大小、参考标准和成像标准进行亚组分析，比较 ECA-MRI 和 HBA-MRI 的诊断性能。
在筛选出的 1760 篇文章中，有 31 篇研究被纳入：15 项研究包括使用 ECA-MRI 成像的 2890 个病变，19 项研究包括使用 HBA-MRI 成像的 3893 个病变。ECA-MRI（敏感性 72%[65-79%]；特异性 92%[89-95%]）和 HBA-MRI（敏感性 76%[68-83%]；特异性 92%[87-95%]）之间的汇总敏感性和特异性无显著差异（p=0.72）。亚组分析未发现 ECA-MRI 和 HBA-MRI 根据研究设计（p≥0.11）、潜在疾病（p≥0.09）、病变大小（≤2cm，p=0.97）、参考标准（p=0.70）或成像标准（p=0.33）之间存在诊断性能差异。
ECA-MRI 在 HCC 的诊断中表现与 HBA-MRI 相似。可以考虑每种造影剂的优势来选择造影剂。
