Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India-160012.
Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India-160012.
J Hepatol. 2021 Jul;75(1):108-119. doi: 10.1016/j.jhep.2021.01.041. Epub 2021 Feb 3.
BACKGROUND & AIMS: Biannual ultrasound has poor sensitivity for hepatocellular carcinoma (HCC) screening. MRI is accurate for the detection of HCC, but a complete MRI is not feasible as a screening tool. Abbreviated MRI (AMRI) is an acceptable alternative. The diagnostic performance of different AMRI protocols is not known. We performed a systematic review to determine the diagnostic accuracy of AMRI for HCC screening.
We searched the MEDLINE and EMBASE databases for studies reporting the diagnostic accuracy of AMRI for HCC screening. The pooled sensitivity and specificity of different AMRI protocols were calculated based on a random intercept logistic regression model. The diagnostic performance of AMRI was compared with ultrasound. Study quality was assessed using the QUADAS-2 tool.
Of the 11,327 studies screened by titles, 15 studies (3 prospective and 12 retrospective: 2,807 patients, 917 with HCC) were included in the final analysis. The pooled per-patient sensitivity and specificity were 86% (95% CI 84-88%, I 0%) and 94% (95% CI 91-96%, I 83%), respectively. Pooled per-lesion sensitivity was 77% (95% CI 74-81%, I 8%). There was no influence of study type, screening setting, reference standard, and presence and etiology of cirrhosis on the performance of AMRI. The sensitivity of AMRI for detection of HCC <2 cm was lower than that for HCC ≥2 cm (69% vs. 86%). The sensitivity and specificity of non-contrast AMRI were comparable to contrast-enhanced AMRI (86% and 94% vs. 87% and 94%, respectively). The diagnostic performance of different non-contrast AMRI and contrast-enhanced AMRI protocols was comparable. The sensitivity of ultrasound was lower than AMRI (53% vs. 82%).
AMRI has high sensitivity and specificity for HCC screening. Different AMRI protocols have comparable diagnostic performance.
Abbreviated MRI (AMRI) has been suggested as an alternative to ultrasound and complete MRI for hepatocellular carcinoma (HCC) screening. Our study results showed that AMRI has a high per-patient and per-lesion sensitivity for HCC. Although the sensitivity of AMRI for detection of HCC <2 cm is considerably lower than for HCC ≥2 cm, it is substantially higher than ultrasound, making it a potential alternative for HCC screening in high-risk populations.
超声检查每半年进行一次，其对肝细胞癌（HCC）筛查的敏感性较差。MRI 检查对 HCC 的检测较为准确，但由于其全面性，MRI 不适用于筛查工具。缩短版 MRI（AMRI）是一种可接受的替代方法。但不同 AMRI 方案的诊断性能尚不清楚。我们进行了一项系统评价，以确定 AMRI 用于 HCC 筛查的诊断准确性。
我们检索了 MEDLINE 和 EMBASE 数据库，以获取报告 AMRI 用于 HCC 筛查的诊断准确性的研究。基于随机截距逻辑回归模型计算了不同 AMRI 方案的汇总敏感性和特异性。比较了 AMRI 和超声的诊断性能。使用 QUADAS-2 工具评估研究质量。
在标题筛选的 11327 项研究中，有 15 项研究（3 项前瞻性和 12 项回顾性：2807 名患者，917 名患有 HCC）最终纳入分析。每位患者的汇总敏感性和特异性分别为 86%（95%CI 84-88%，I²=0%）和 94%（95%CI 91-96%，I²=83%）。每例病变的汇总敏感性为 77%（95%CI 74-81%，I²=8%）。研究类型、筛查环境、参考标准以及肝硬化的存在和病因均不影响 AMRI 的性能。AMRI 检测 HCC <2 cm 的敏感性低于 HCC ≥2 cm（69% vs. 86%）。非增强 AMRI 的敏感性和特异性与增强 AMRI 相当（分别为 86%和 94%与 87%和 94%）。不同非增强 AMRI 和增强 AMRI 方案的诊断性能相当。超声的敏感性低于 AMRI（53% vs. 82%）。
AMRI 对 HCC 筛查具有较高的敏感性和特异性。不同的 AMRI 方案具有相当的诊断性能。
作为超声和完整 MRI 的替代方法，缩短版 MRI（AMRI）已被提议用于肝细胞癌（HCC）筛查。我们的研究结果表明，AMRI 对 HCC 的患者和病变均具有较高的敏感性。尽管 AMRI 检测 HCC <2 cm 的敏感性明显低于 HCC ≥2 cm，但明显高于超声，因此可能成为高危人群 HCC 筛查的一种替代方法。
