Contrast-enhanced US for characterization of focal liver lesions: a comprehensive meta-analysis

Abstract

Objectives

This meta-analysis was performed to evaluate the accuracy of contrast-enhanced ultrasound (CEUS) in differentiating malignant from benign focal liver lesions (FLLs).

Methods

Cochrane Library, PubMed and Web of Science databases were systematically searched and checked for studies using CEUS in characterization of FLLs. Data necessary to construct 2×2 contingency tables were extracted from included studies. The QUADAS tool was utilized to assess the methodologic quality of the studies. Meta-analysis included data pooling, subgroup analyses, meta-regression and investigation of publication bias was comprehensively performed.

Results

Fifty-seven studies were included in this meta-analysis and the overall diagnostic accuracy in characterization of FLLs was as follows: pooled sensitivity, 0.92 (95%CI: 0.91–0.93); pooled specificity, 0.87 (95%CI: 0.86–0.88); diagnostic odds ratio, 104.20 (95%CI: 70.42–154.16). Subgroup analysis indicated higher diagnostic accuracy of the second-generation contrast agents (CAs) than the first-generation CA (Levovist; DOR: 118.27 vs. 62.78). Furthermore, Sonazoid demonstrated the highest diagnostic accuracy among three major CAs (SonoVue, Levovist and Sonazoid; DOR: 118.82 vs. 62.78 vs. 227.39). No potential publication bias was observed of the included studies.

Conclusion

CEUS is an accurate tool to stratify the risk of malignancy in FLLs. The second-generation CAs, especially Sonazoid may greatly improve diagnostic performance.

Key Points

CEUS shows excellent diagnostic accuracy in differentiating malignant from benign FLLs.

The second-generation CAs have higher diagnostic accuracy than first-generation CAs.

Sonazoid demonstrates the highest diagnostic accuracy among three major CAs.

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Abbreviations

CEUS:

Contrast-enhanced ultrasound

FLLs:

Focal liver lesions

CAs:

Contrast agents

CA:

Contrast agent

QUADAS:

Quality Assessment of Diagnostic Accuracy Studies

TP:

True positive

TN:

True negative

FP:

False positive

FN:

False negative

DOR:

Diagnostic odds ratio

PLR:

Positive likelihood ratio

NLR:

Negative likelihood ratio

CIs:

Confidence intervals

HSROC:

Hierarchical summary receiver operating characteristic

AUC:

Area under the curve

RDOR:

Relative diagnostic odds ratio

UL:

Upper limit

LL:

Lower limit

HCCs:

Hepatocellular carcinomas

RES:

Reticuloendothelial system

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Funding

This study has received funding by the Youth Science Foundation of the Second Hospital Center Laboratory of Tianjin Medical University (2016YDEY01), Science Foundation of Tianjin Medical University (2016KYZQ06 and 2014KYM15), Foundation of Tianjin Health and Family Planning Commission (16KG115).

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Correspondence to Xue Li or Xuening Zhang.

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The scientific guarantor of this publication is Xuening Zhang.

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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.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was not required for this study because the study concerns a meta-analysis.

Ethical approval

Institutional review board approval was not required because the study concerns a meta-analysis.

Methodology

• diagnostic study

• performed at one institution

Additional information

Menglin Wu and Liang Li are co-first authors.

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Wu, M., Li, L., Wang, J. et al. Contrast-enhanced US for characterization of focal liver lesions: a comprehensive meta-analysis. Eur Radiol 28, 2077–2088 (2018). https://doi.org/10.1007/s00330-017-5152-x

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Keywords

  • Ultrasonography
  • Contrast media
  • Liver neoplasms
  • Diagnosis
  • Meta-analysis