A meta-analysis of diffusion-weighted and gadoxetic acid-enhanced MR imaging for the detection of liver metastases
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To obtain the diagnostic performance of diffusion-weighted (DW) and gadoxetic-enhanced magnetic resonance (MR) imaging in the detection of liver metastases.
A comprehensive search (EMBASE, PubMed, Cochrane) was performed to identify relevant articles up to June 2015. Inclusion criteria were: liver metastases, DW-MR imaging and/or gadoxetic acid-enhanced MR imaging, and per-lesion statistics. The reference standard was histopathology, intraoperative observation and/or follow-up. Sources of bias were assessed using the QUADAS-2 tool. A linear mixed-effect regression model was used to obtain sensitivity estimates.
Thirty-nine articles were included (1,989 patients, 3,854 metastases). Sensitivity estimates for DW-MR imaging, gadoxetic acid-enhanced MR imaging and the combined sequence for detecting liver metastases on a per-lesion basis was 87.1 %, 90.6 % and 95.5 %, respectively. Sensitivity estimates by gadoxetic acid-enhanced MR imaging and the combined sequence were significantly better than DW-MR imaging (p = 0.0001 and p < 0.0001, respectively), and the combined MR sequence was significantly more sensitive than gadoxetic acid-enhanced MR imaging (p < 0.0001). Similar results were observed in articles that compared the three techniques simultaneously, with only colorectal liver metastases and in liver metastases smaller than 1 cm.
In patients with liver metastases, combined DW-MR and gadoxetic acid-enhanced MR imaging has the highest sensitivity for detecting liver metastases on a per-lesion basis.
• DW-MRI is less sensitive than gadoxetic acid-enhanced MRI for detecting liver metastases
• DW-MRI and gadoxetic acid-enhanced MRI is the best combination
• Same results are observed in colorectal liver metastases
• Same results are observed in liver metastases smaller than 1 cm
• Same results are observed when histopathology alone is the reference standard
KeywordsLiver metastases, diagnosis Liver metastases, MR imaging Liver metastases, meta-analysis Liver MRI
The scientific guarantor of this publication is Valérie Vilgrain. 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. This study has received funding by the French Ministry of Health, PHRC, AOM 08-114. The authors thank The Ligue Nationale Contre le Cancer for supporting meta-analysis in cancer.
One of the authors has significant statistical expertise. Institutional Review Board approval was not required because this study is a meta-analysis. Written informed consent was not required for this study because this study is a meta-analysis. Methodology: retrospective, meta-analysis, performed at one institution.
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