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Diagnostic performance of MRI for HCC according to contrast agent type: a systematic review and meta-analysis

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Abstract

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).

Methods

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.

Results

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).

Conclusion

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.

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Funding

This work was supported by a National Research Foundation of Korea (NRF) grant funded by the Korean government (MSIT) (Grant No. NRF-2019R1G1A1099743) and 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 No. HI18C2383).

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Authors and Affiliations

  1. 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

    Dong Wook Kim, Sang Hyun Choi, So Yeon Kim, Jae Ho Byun, Seung Soo Lee, Seong Ho Park & Kyung Won Kim

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  1. Dong Wook Kim
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  2. Sang Hyun Choi
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  3. So Yeon Kim
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Contributions

SHC and SYK contributed to the study concept and design. DWK and SHC acquired and analyzed the data. SHC, SHP, and KWK performed the statistical analysis. DWK and SHC drafted the manuscript. SYK, JHB, and SSL made critical revisions to the manuscript.

Corresponding author

Correspondence to Sang Hyun Choi.

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Conflict of interest

Sang Hyun Choi receives research funding from Bayer Healthcare. The other authors (Dong Wook Kim, So Yeon Kim, Jae Ho Byun, Seung Soo Lee, Seong Ho Park and Kyung Won Kim) have no conflicts of interest to declare.

Statement of ethics

Institutional Review Board approval was not required due to the study design, which was a systemic review and meta-analysis.

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Kim, D.W., Choi, S.H., Kim, S.Y. et al. Diagnostic performance of MRI for HCC according to contrast agent type: a systematic review and meta-analysis. Hepatol Int 14, 1009–1022 (2020). https://doi.org/10.1007/s12072-020-10100-7

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  • DOI: https://doi.org/10.1007/s12072-020-10100-7

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