Tumor Biology

, Volume 36, Issue 2, pp 983–990 | Cite as

Differential diagnosis between hepatic metastases and benign focal lesions using DWI with parallel acquisition technique: a meta-analysis

  • Chenggang Wei
  • Jieying Tan
  • Li Xu
  • Liu Juan
  • Si Wei Zhang
  • Lu Wang
  • Qun Wang
Research Article

Abstract

We aim to investigate the diagnostic capability of diffusion-weighted imaging using parallel acquisition technique for the differentiation between hepatic metastases and benign focal lesions with a meta-analysis. The meta-analysis included a total of 858 hepatic metastases and 440 benign liver lesions from nine studies. The pooled sensitivity and specificity of diffusion-weighted imaging (DWI) were 0.87 (95 % CI, 0.84–0.89) and 0.90 (95 % CI, 0.87–0.93), respectively. The positive likelihood ratio (PLR) and negative likelihood ratio (NLR) were 8.50 (95 % CI, 4.97–14.52) and 0.17 (95 % CI, 0.11–0.26), respectively. The P value for χ 2 heterogeneity for all pooled estimates was <0.05. From the fitted summary receiver operating characteristics (SROC), the area under the curve (AUC) and Q* index were 0.95 and 0.88, respectively. Publication bias is not present (t = −0.76, P = 0.471). The meta-regression analysis indicated that evaluated covariates included patient number, patient population, mean age, maximum of b factor, number of cysts, number of hemangiomas, and field were not sources of heterogeneity (all P value >0.05). Diffusion-weighted imaging was useful for differentiation between hepatic metastases and benign focal lesions. The diffusion characteristics of the benign hepatocellular lesions, including cases of focal nodular hyperplasia (FNH) and adenoma, have rarely been reported and need further studies. The diagnostic capability of DWI with parallel acquisition technique for differentiation between metastases and benign hepatic focal lesions might be overestimated.

Keywords

Meta-analysis Diffusion-weighted imaging Hepatic metastases 

References

  1. 1.
    Hardie AD, Naik M, Hecht EM, Chandarana H, Mannelli L, Babb JS, et al. Diagnosis of liver metastases: value of diffusion-weighted MRI compared with gadolinium-enhanced MRI. Eur Radiol. 2010;20:1431–41.CrossRefPubMedGoogle Scholar
  2. 2.
    Benoist S, Nordlinger B. The role of preoperative chemotherapy in patients with resectable colorectal liver metastases. Ann Surg Oncol. 2009;16:2385–90.CrossRefPubMedGoogle Scholar
  3. 3.
    Cummings LC, Payes JD, Cooper GS. Survival after hepatic resection in metastatic colorectal cancer: a population-based study. Cancer. 2007;109:718–26.CrossRefPubMedGoogle Scholar
  4. 4.
    Gillams AR, Lees WR. Five-year survival in 309 patients with colorectal liver metastases treated with radiofrequency ablation. Eur Radiol. 2009;19:1206–13.CrossRefPubMedGoogle Scholar
  5. 5.
    Pozzo C, Barone C, Kemeny NE. Advances in neoadjuvant therapy for colorectal cancer with liver metastases. Cancer Treat Rev. 2008;34:293–301.CrossRefPubMedGoogle Scholar
  6. 6.
    Takakura Y, Okajima M, Kanemitsu Y, Kuroda S, Egi H, Hinoi T, et al. External validation of two nomograms for predicting patient survival after hepatic resection for metastatic colorectal cancer. World J Surg. 2011;35:2275–82.CrossRefPubMedGoogle Scholar
  7. 7.
    Mannelli L, Bhargava P, Osman SF, Raz E, Moshiri M, Laffi G, et al. Diffusion-weighted imaging of the liver: a comprehensive review. Curr Probl Diagn Radiol. 2013;42:77–83.CrossRefPubMedGoogle Scholar
  8. 8.
    Pruessmann KP, Weiger M, Scheidegger MB, Boesiger P. SENSE: sensitivity encoding for fast MRI. Magnet Res Med Off J Soc Magnet Res Med Soc Magnet Res Med. 1999;42:952–62.CrossRefGoogle Scholar
  9. 9.
    Kurihara Y, Yakushiji YK, Tani I, Nakajima Y, Van Cauteren M. Coil sensitivity encoding in MR imaging: advantages and disadvantages in clinical practice. AJR Am J Roentgenol. 2002;178:1087–91.CrossRefPubMedGoogle Scholar
  10. 10.
    Nasu K, Kuroki Y, Nawano S, Kuroki S, Tsukamoto T, Yamamoto S, et al. Hepatic metastases: diffusion-weighted sensitivity-encoding versus SPIO-enhanced MR imaging. Radiology. 2006;239:122–30.CrossRefPubMedGoogle Scholar
  11. 11.
    Wu LM, Hu J, Gu HY, Hua J, Xu JR. Can diffusion-weighted magnetic resonance imaging (DW-MRI) alone be used as a reliable sequence for the preoperative detection and characterisation of hepatic metastases? A meta-analysis. Eur J Cancer. 2013;49:572–84.CrossRefPubMedGoogle Scholar
  12. 12.
    Bruegel M, Gaa J, Waldt S, Woertler K, Holzapfel K, Kiefer B, et al. Diagnosis of hepatic metastasis: comparison of respiration-triggered diffusion-weighted echo-planar MRI and five t2-weighted turbo spin-echo sequences. AJR Am J Roentgenol. 2008;191:1421–9.CrossRefPubMedGoogle Scholar
  13. 13.
    Holzapfel K, Reiser-Erkan C, Fingerle AA, Erkan M, Eiber MJ, Rummeny EJ, et al. Comparison of diffusion-weighted MR imaging and multidetector-row CT in the detection of liver metastases in patients operated for pancreatic cancer. Abdom Imaging. 2011;36:179–84.CrossRefPubMedGoogle Scholar
  14. 14.
    Kim H, Yu JS, Cho ES, Chung JJ, Kim JH, Kim D, et al. Diffusion-weighted imaging versus superparamagnetic iron oxide (SPIO)-enhanced MRI: exclusive and combined values in the assessment of hepatic metastases. Magnetic resonance imaging 2012;30:554–61.Google Scholar
  15. 15.
    Koh DM, Brown G, Riddell AM, Scurr E, Collins DJ, Allen SD, et al. Detection of colorectal hepatic metastases using MnDPDP MR imaging and diffusion-weighted imaging (DWI) alone and in combination. Eur Radiol. 2008;18:903–10.CrossRefPubMedGoogle Scholar
  16. 16.
    Lowenthal D, Zeile M, Lim WY, Wybranski C, Fischbach F, Wieners G, et al. Detection and characterisation of focal liver lesions in colorectal carcinoma patients: comparison of diffusion-weighted and Gd-EOB-DTPA enhanced MR imaging. Eur Radiol. 2011;21:832–40.CrossRefPubMedGoogle Scholar
  17. 17.
    Shimada K, Isoda H, Hirokawa Y, Arizono S, Shibata T, Togashi K. Comparison of gadolinium-EOB-DTPA-enhanced and diffusion-weighted liver MRI for detection of small hepatic metastases. Eur Radiol. 2010;20:2690–8.CrossRefPubMedGoogle Scholar
  18. 18.
    Soyer P, Boudiaf M, Place V, Sirol M, Pautrat K, Vignaud A, et al. Preoperative detection of hepatic metastases: comparison of diffusion-weighted, T2-weighted fast spin echo and gadolinium-enhanced MR imaging using surgical and histopathologic findings as standard of reference. Eur J Radiol. 2011;80:245–52.CrossRefPubMedGoogle Scholar
  19. 19.
    Knechtle SJ, Pirsch JD, Fechner HJJ, Becker BN, Friedl A, Colvin RB, et al. Campath-1H induction plus rapamycin monotherapy for renal transplantation: results of a pilot study. Am J Transplant Off J Am Soc Transplant Am Soc Transplant Surg. 2003;3:722–30.CrossRefGoogle Scholar
  20. 20.
    Kanematsu M, Goshima S, Watanabe H, Kondo H, Kawada H, Noda Y, et al. Detection and characterization of focal hepatic lesions with diffusion-weighted MR imaging: a pictorial review. Abdom Imaging. 2013;38:297–308.CrossRefPubMedGoogle Scholar
  21. 21.
    Xia D, Jing J, Shen H, Wu J. Value of diffusion-weighted magnetic resonance images for discrimination of focal benign and malignant hepatic lesions: a meta-analysis. J Magnet Res Imaging JMRI. 2010;32:130–7.CrossRefGoogle Scholar
  22. 22.
    Zamora J, Abraira V, Muriel A, Khan K, Coomarasamy A. Meta-DiSc: a software for meta-analysis of test accuracy data. BMC Med Res Methodol. 2006;6:31.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Li Y, Chen Z, Wang J. Differential diagnosis between malignant and benign hepatic tumors using apparent diffusion coefficient on 1.5-T MR imaging: a meta analysis. Eur J Radiol. 2012;81:484–90.CrossRefPubMedGoogle Scholar
  24. 24.
    Cuzick J. Forest plots and the interpretation of subgroups. Lancet. 2005;365:1308.CrossRefPubMedGoogle Scholar
  25. 25.
    Ho KM. Forest and funnel plots illustrated the calibration of a prognostic model: a descriptive study. J Clin Epidemiol. 2007;60:746–51.CrossRefPubMedGoogle Scholar
  26. 26.
    Souza JP, Pileggi C, Cecatti JG. Assessment of funnel plot asymmetry and publication bias in reproductive health meta-analyses: an analytic survey. Reprod Health. 2007;4:3.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Yeh J, D’Amico F. Forest plots: data summaries at a glance. J Fam Practice. 2004;53:1007.Google Scholar

Copyright information

© International Society of Oncology and BioMarkers (ISOBM) 2014

Authors and Affiliations

  • Chenggang Wei
    • 1
  • Jieying Tan
    • 2
  • Li Xu
    • 3
    • 6
  • Liu Juan
    • 4
  • Si Wei Zhang
    • 3
  • Lu Wang
    • 3
  • Qun Wang
    • 5
  1. 1.Department of Radiology, Guangzhou First People’s HospitalGuangzhou Medical UniversityGuangzhouChina
  2. 2.Department of Medical Imaging, Guangzhou Nansha Central Hospital, Guangzhou First People’s HospitalGuangzhou Medical UniversityGuangzhouChina
  3. 3.Department of RadiologyGuangdong Provincial Traditional Chinese Medicine HospitalGuangzhouChina
  4. 4.Department of PharmacyGuangdong Provincial Traditional Chinese Medicine HospitalGuangzhouChina
  5. 5.Jishou UniversityJishouChina
  6. 6.Guangdong Provincial Traditional Chinese Medicine HospitalGuangzhouChina

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