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Clinical usefulness of multiple arterial-phase images in gadoxetate disodium-enhanced magnetic resonance imaging: a systematic review and meta-analysis

  • Magnetic Resonance
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

The multiple arterial-phase (AP) technique was introduced for liver MRI, but it is not really known if multiple AP MRI (MA-MRI) improves image quality and lesion detection rate on gadoxetate disodium–enhanced MRI in comparison with single AP MRI (SA-MRI). We aimed to determine the clinical usefulness of MA-MRI in comparison with SA-MRI.

Methods

Original articles reporting the percentage of adequate AP imaging and the lesion detection rate on gadoxetate disodium–enhanced MA-MRI were identified in PubMed, EMBASE, and Cochrane Library databases. The pooled percentage of adequate AP imaging and lesion detection rate were calculated using random-effects meta-analysis of single proportions. Subgroup analysis was performed to explain causes of study heterogeneity, and publication bias was evaluated using Egger’s test.

Results

Of 772 articles screened, 22 studies in 12 articles were included: 18 studies (ten MA-MRI and eight SA-MRI) suitably defined the percentage of adequate AP imaging and four (three MA-MRI and one SA-MRI) defined the lesion detection rate. MA-MRI had 16.1% higher pooled percentage of adequate AP imaging than SA-MRI (94.8% vs. 78.7%, p < 0.01). MA-MRI additionally detected 33.2% of lesions than SA-MRI (83.2% vs. 50.0%, p = 0.06). Substantial study heterogeneity was found in MA-MRI, and the definition of adequate AP imaging, lesion characteristics, and reference standards were significant factors affecting study heterogeneity (p ≤ 0.02). Significant publication bias was found in MA-MRI (p < 0.01) but not in SA-MRI studies (p = 0.87).

Conclusions

Gadoxetate disodium–enhanced MA-MRI may be more clinically useful than SA-MRI, but further study is necessary to validate this finding because of study heterogeneity and publication bias.

Key Points

• Multiple arterial-phase MRI (MA-MRI) had a 16.1% higher pooled percentage of adequate AP imaging than single arterial-phase MRI (SA-MRI) (94.8% vs. 78.7%, p < 0.01).

• MA-MRI additionally detected an extra 33.2% of lesions compared with SA-MRI (83.2% vs. 50.0%, p = 0.06).

• Substantial study heterogeneity and significant publication bias were found across MA-MRI studies.

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Abbreviations

AP :

Arterial-phase

APHE :

Arterial-phase hyperenhancement

HCC :

Hepatocellular carcinoma

MA-MRI :

Multiple arterial-phase magnetic resonance imaging

PRISMA :

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

QUADAS-2 :

Quality Assessment of Diagnostic Accuracy Studies-2

SA-MRI :

Single arterial-phase magnetic resonance imaging

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Funding

This work was supported by a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (grant number: HI17C-1862-020018) and the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIT) (grant number: NRF-2019R1G1A1099743).

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Authors and Affiliations

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

    Sun Hong, Sang Hyun Choi, So Yeon Kim & Seung Soo Lee

  2. Department of Radiology, Biomedical Research Institute, Pusan National University Hospital and Pusan National University School of Medicine, 179 Gudeok-ro, Seo-gu, Busan, 49241, Republic of Korea

    Seung Baek Hong

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  1. Sun Hong
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Correspondence to Sang Hyun Choi.

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Ethics approval

Institutional Review Board approval was not required because of the study nature of meta-analysis.

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Informed consent was not required because of the study nature of meta-analysis.

Conflict of interest

Sang Hyun Choi receives research funding from Bayer Healthcare outside the submitted work. The other authors have no conflicts of interest to declare.

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The scientific guarantor of this publication is Sang Hyun Choi.

Statistics and biometry

Sang Hyun Choi has significant statistical expertise

Methodology

• Systematic Review

• Meta-analysis

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Hong, S., Choi, S.H., Hong, S.B. et al. Clinical usefulness of multiple arterial-phase images in gadoxetate disodium-enhanced magnetic resonance imaging: a systematic review and meta-analysis. Eur Radiol 32, 5413–5423 (2022). https://doi.org/10.1007/s00330-022-08620-x

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  • DOI: https://doi.org/10.1007/s00330-022-08620-x

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