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Imaging features of hepatocellular carcinoma in nonalcoholic fatty liver disease and nonalcoholic steatohepatitis: a systematic review and meta-analysis

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Abstract

Purpose

To investigate the imaging features of hepatocellular carcinoma (HCC) in patients with non-alcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) through a systematic review and meta-analysis.

Methods

MEDLINE, EMBASE, and the Cochrane Library database were searched for studies providing data on imaging features of HCC in NAFLD and NASH between January 1, 2011 and July 19, 2021. Random effects models were used to calculate the pooled percentages of the three major features of arterial-phase hyperenhancement (APHE), washout, and enhancing capsule. Sensitivity analysis and subgroup analysis were performed according to underlying liver disease (NASH vs. NAFLD) and imaging modality (CT vs. MRI).

Results

Five studies (170 patients with 193 HCCs) were included in the analysis. The pooled percentages of APHE, washout, and enhancing capsule were 94.0% (95% confidence interval [CI] 89.1–96.7%), 72.7% (95% CI 63.3–80.4%), and 57.5% (95% CI 45.1–69.1%), respectively. The percentages of these three major features did not significantly differ between NAFLD and NASH (p ≥ 0.21). MRI showed similar pooled percentages of APHE (94.3% vs. 93.4%, p = 0.82) and washout (70.4% vs. 77.2%, p = 0.38) to CT, but a higher pooled percentage of enhancing capsule (67.1% vs. 44.7%, p = 0.02).

Conclusion

HCC in patients with NAFLD and NASH had a similar frequency of APHE to HCC with other etiology. However, it showed a relatively low frequency of washout and enhancing capsule.

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Authors and Affiliations

  1. Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan Collage of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea

    Eun Joo Park & Sang Hyun Choi

  2. Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, 875 Haeundae-ro, Haeundae-gu, Busan, 48108, Republic of Korea

    Eun Joo Park & Jung Hee Son

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  1. Eun Joo Park
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Park, E.J., Son, J.H. & Choi, S.H. Imaging features of hepatocellular carcinoma in nonalcoholic fatty liver disease and nonalcoholic steatohepatitis: a systematic review and meta-analysis. Abdom Radiol 47, 2089–2098 (2022). https://doi.org/10.1007/s00261-022-03499-0

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