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Comparative 13-year meta-analysis of the sensitivity and positive predictive value of ultrasound, CT, and MRI for detecting hepatocellular carcinoma

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Abstract

Purpose

To compare the per-lesion sensitivity and positive predictive value (PPV) of ultrasonography (US), computed tomography (CT), and magnetic resonance imaging (MRI) for the diagnosis of hepatocellular carcinoma (HCC).

Materials and methods

The meta-analysis of sensitivity included 242 studies (15,713 patients); 116 studies (7492 patients) allowed calculation of PPV. Pooled per-lesion sensitivity and PPV for HCC detection were compared using empirical Bayes estimates of a beta-binomial model.

Results

The pooled per-lesion sensitivity and PPV of contrast-enhanced CT (73.6%, 85.8%) and gadolinium-enhanced MRI (77.5%, 83.6%) are not significantly different (P = 0.08, P = 0.2). However, if the hepatobiliary agent gadoxetate is used, MRI has significantly higher pooled per-lesion sensitivity and PPV (85.6%, 94.2%) than CT (P < 0.0001) or than MRI with other agents (P < 0.0001). Non-contrast-enhanced US has the lowest overall sensitivity and PPV (59.3%, 77.4%). Pooled per-lesion sensitivity and PPV of contrast-enhanced US (84.4%, 89.3%) are relatively high, but no contrast-enhanced US study used the most rigorous reference standards.

Conclusion

MRI utilizing the hepatobiliary agent gadoxetate has the highest overall sensitivity and PPV, and may be the single optimal method for diagnosis of HCC. Non-contrast-enhanced US has the lowest sensitivity and PPV. More rigorous reference standards are needed to compare the performance of contrast-enhanced US with CT and MRI. Differences in sensitivity and PPV between CT and conventional gadolinium-enhanced MRI are not statistically significant overall.

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Abbreviations

CEUS:

Contrast-enhanced ultrasound

CT:

Computed tomography

GdMR:

Gadolinium-enhanced magnetic resonance imaging without inclusion of hepatobiliary phase

GxMR:

Gadolinium-enhanced magnetic resonance imaging utilizing the hepatobiliary agent gadoxetate

HCC:

Hepatocellular carcinoma

MRI:

Magnetic resonance imaging

NEUS:

Non-contrast-enhanced ultrasound

PPV:

Positive predictive value

SpMR:

Superparamagnetic iron oxide-enhanced magnetic resonance imaging

US:

Ultrasound

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    Authors and Affiliations

    1. Department of Diagnostic Radiology, Columbia University, New York Presbyterian Hospital, 622 West 168th Street, New York, NY, 10032, USA

      Robert F. Hanna, Vesselin Z. Miloushev, Lee A. Finklestone, Sidney Z. Brejt & Ranjit S. Sandhu

    2. Department of Radiology, Hôpital Saint-Luc, University of Montreal, 1058 Rue Saint-Denis, Montreal, QC, H2X 3J4, Canada

      An Tang

    3. Liver Imaging Group, Department of Radiology, University of California San Diego, 200 W Arbor Drive, San Diego, CA, 92103, USA

      Cynthia S. Santillan & Claude B. Sirlin

    4. Computational and Applied Statistics Laboratory (CASL), SDSC, University of California at San Diego, MC 0505, 9500 Gilman Dr., La Jolla, CA, 92093-0505, USA

      Tanya Wolfson & Anthony Gamst

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    Robert F. Hanna and Vesselin Z. Miloushev have contributed equally to this work.

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    Hanna, R.F., Miloushev, V.Z., Tang, A. et al. Comparative 13-year meta-analysis of the sensitivity and positive predictive value of ultrasound, CT, and MRI for detecting hepatocellular carcinoma. Abdom Radiol 41, 71–90 (2016). https://doi.org/10.1007/s00261-015-0592-8

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