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Detection of liver metastases on gadobenate dimeglumine-enhanced MRI: systematic review, meta-analysis, and similarities with gadoxetate-enhanced MRI

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Abstract

Objectives

To determine the sensitivity and positive predictive value (PPV) of gadobenate-enhanced MR imaging for the detection of liver metastases.

Methods

This systematic review and meta-analysis was conducted according to PRISMA guidelines. A comprehensive search (EMBASE, PubMed) was performed to identify relevant articles up to December 2017. Studies eligible for inclusion were performed using appropriate methodology with complete verification by means of histopathology, intraoperative observation and/or follow-up, and sufficient information to permit determination of true-positive (TP), false-negative (FN), and false-positive (FP) values. Sources of bias were assessed using the QUADAS-2 tool. An inverse variance-weighted random-effects model was used to obtain sensitivity and PPV estimates. Information was analyzed and presented using Cochran’s Q statistic, funnel plots, and modified Deeks’ analysis.

Results

Ten articles (256 patients, 562 metastases) were included. Sensitivity estimates for pre-contrast (unenhanced) imaging, gadobenate-enhanced dynamic imaging, and combined unenhanced, dynamic, and delayed hepatobiliary phase imaging for detecting liver metastases on a per-lesion basis were 77.8% (95% CI 71.4–84.3%, 7 assessments), 88.1% (95% CI, 84.0–92.2%, 13 assessments), and 95.1% (95% CI 93.1–97.1%, 15 assessments), respectively. The addition of hepatobiliary phase images significantly improved the detection of liver metastases. The overall PPV was 90.9% (95% CI 86.6–95.1%, 11 assessments). Deeks’ funnel analysis revealed no association between sample size and sensitivity (β = 0.02, p = 0.814) indicating no significant publication bias.

Conclusions

Gadobenate-enhanced MR imaging has high sensitivity and PPV for the detection of liver metastases on a per-lesion basis. The sensitivity and PPV for detection is comparable to reported values for the pure liver-specific agent gadoxetate.

Key Points

• Gadobenate dimeglumine is a hepatobiliary MR contrast agent that permits acquisition of contrast-enhanced liver images during the immediate post-injection dynamic phase, like any extracellular agent, and in the delayed hepatobiliary phase, after specific uptake by the hepatocytes.

• The hepatobiliary phase improves detection of liver metastases when compared either to pre-contrast unenhanced images alone or to pre-contrast + gadobenate-enhanced dynamic phase images.

• The meta-analysis showed an overall sensitivity of 95.1% and PPV of 90.9% of gadobenate-enhanced MRI for the detection of metastases, when based on the evaluation of all available acquisitions.

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Abbreviations

CI:

Confidence interval

DWI:

Diffusion-weighted imaging

FN:

False negative

FP:

False positive

GBCA:

Gadolinium-based contrast agent

IOUS:

Intraoperative ultrasound

MRI:

Magnetic resonance imaging

NAC:

Neoadjuvant chemotherapy

PET/CT:

Positron emission tomography/computerized tomography

PPV:

Positive predictive value

PRISMA:

Preferred reporting items for systematic reviews and meta-analyses

QUADAS:

Quality assessment of diagnostic accuracy studies

TP:

True positive

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Funding

The authors state that this work has not received any funding.

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Author notes

  1. Ling Zhang and Xian Yu contributed equally to this work.

Authors and Affiliations

  1. Department of Radiology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China

    Ling Zhang

  2. Department of gastrointestinal surgery, Chongqing University Cancer Hospital & Chongqing Cancer Institute & Chongqing Cancer Hospital, Chongqing, China

    Xian Yu

  3. Department of Radiology, Shanghai Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China

    Lei Huo, Lun Lu, Xinpeng Pan & Ningyang Jia

  4. Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China

    Xinxiang Fan

  5. Department of Radiology, Ospedale Ca’ Foncello, Treviso, Italy

    Giovanni Morana

  6. Department of Radiology, University of Brescia, Ospedale “Spedali Civili”, Brescia, Italy

    Luigi Grazioli

  7. Department of Radiology, Saarland University Medical Center, Homburg, Saar, Germany

    Guenther Schneider

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  1. Ling Zhang
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  4. Lun Lu
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Corresponding authors

Correspondence to Ningyang Jia or Xinxiang Fan.

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The scientific guarantor of this publication is Hongyan Chen.

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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.

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Written informed consent was not required for this study because it is a meta-analysis on published literature.

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Zhang, L., Yu, X., Huo, L. et al. Detection of liver metastases on gadobenate dimeglumine-enhanced MRI: systematic review, meta-analysis, and similarities with gadoxetate-enhanced MRI. Eur Radiol 29, 5205–5216 (2019). https://doi.org/10.1007/s00330-019-06110-1

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