The diagnostic value of Gd-EOB-DTPA-MRI for the diagnosis of focal nodular hyperplasia: a systematic review and meta-analysis
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We aimed to systematically review the gadoxetic acid-enhanced magnetic resonance imaging (Gd-EOB-DTPA-MRI) findings of focal nodular hyperplasia (FNH) and its diagnostic value.
A thorough literature search was conducted in Ovid-MEDLINE and EMBASE databases to identify studies evaluating Gd-EOB-DTPA-MRI findings of FNH. To evaluate the frequency of characteristic imaging findings on Gd-EOB-DTPA-MRI, pooled proportions of high/iso signal intensity (SI) on the hepatobiliary phase (HBP), arterial enhancement, high/iso SI on the portal-venous phase (PVP) or equilibrium phase (EP), and the central scar were calculated. Meta-analysis was performed to evaluate the diagnostic accuracy of high/iso SI on HBP for distinguishing FNH from hepatocellular adenoma.
A review of 96 articles identified ten eligible articles with 304 patients with FNHs for meta-analysis. Pooled proportion of the Gd-EOB-DTPA-MRI findings showed that high/iso SI on the HBP, arterial enhancement, and high/iso SI on the PVP/EP were observed in 93% (95% CI, 90–97%), 99% (95% CI, 97–100%), and 97% (95% CI, 95–99%) of FNHs, respectively, while a central scar was observed in 61% of FNHs (95% CI, 47–74%). High/iso SI on the HBP was highly accurate for distinguishing FNH from hepatocellular adenoma, with a summary sensitivity of 93.9% (95% CI, 89.1–97.1%) and a specificity of 95.3% (95% CI, 88.4–98.7%).
High/iso SI on the HBP of Gd-EOB-DTPA-MRI is characteristic and a prevalent finding of FNHs and can be helpful in the management of patients with FNH.
• The vast majority (94–97 %) of FNHs show high/iso SI on HBP.
• High/iso SI on HBP was accurate for distinguishing FNH from hepatocellular adenoma.
• HBP of Gd-EOB-DTPA-MRI can reduce unnecessary biopsies for the diagnosis of FNHs.
KeywordsFocal nodular hyperplasia Gadoxetic acid Gd-EOB-DTPA Magnetic resonance imaging Hepatocellular adenoma
The scientific guarantor of this publication is Hyun Kwon Ha. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. One of the authors (Kyung Won Kim) has significant statistical expertise. Institutional Review Board approval was obtained. Neither Institutional Review Board approval nor written informed consent were required required for this study, because of the nature of our study, which was a systemic review and meta-analysis. Methodology: Meta-analysis, performed at one institution.
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