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Is Liver-Specific Gadoxetic Acid-Enhanced Magnetic Resonance Imaging a Reliable Tool for Detection of Hepatocellular Carcinoma in Patients with Chronic Liver Disease?

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Abstract

Background

Gadoxetic acid is a recently developed hepatobiliary-specific contrast material used for magnetic resonance imaging (MRI) which enables highly sensitive detection of hepatocellular carcinoma (HCC).

Aim

We performed a meta-analysis of all available studies of the diagnostic performance of gadoxetic acid-enhanced MRI (Gd-EOB-MRI) for detection of HCC in patients with chronic liver disease.

Methods

Databases including MEDLINE and EMBASE were searched for relevant original articles published from January 2000 to April 2012. Pooled estimation and subgroup analysis data were obtained by statistical analysis.

Results

Across 10 studies of 570 patients, Gd-EOB-MRI sensitivity was 0.91 (95 % CI 0.77, 0.97) and specificity was 0.93 (95 % CI 0.85, 0.97). Overall, LR+ was 13.6 (95 % CI 5.6, 33.2), LR− was 0.10 (95 % CI 0.04, 0.27), and DOR was 140.36 (95 % CI 28, 696). Among patients with high pre-test probabilities, MRI enabled confirmation of HCC; among patients with low pre-test probabilities, MRI enabled exclusion of HCC. Worst-case-scenario (pre-test probability, 50 %) post-test probabilities were 93 and 9 % for positive and negative MRI results, respectively. In studies in which both Gd-EOB-MRI and contrast enhanced computed tomography (CE-CT) were performed, Gd-EOB-MRI was more sensitive than CE-CT (0.93 vs. 0.78; p < 0.05). Subgroup analysis suggested average lesion size (<2 vs. >2 cm) did not affect the diagnostic accuracy of the test (p > 0.05).

Conclusions

A limited number of small studies suggest Gd-EOB-MRI has good diagnostic performance in the detection of HCC among patients with chronic liver disease. It is also confirmed to be a reliable tool for evaluation of small early-stage HCC.

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Authors and Affiliations

  1. Department of Radiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, 1630 Dongfang Road, Shanghai, 200127, China

    Lian-Ming Wu, Jian-Rong Xu, Hai-Yan Gu, Jia Hua, Jie Chen, Jiong Zhu & Wei Zhang

  2. Department of Radiology, Wayne State University, Detroit, MI, 48201, USA

    Jiani Hu

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Correspondence to Jian-Rong Xu.

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Wu, LM., Xu, JR., Gu, HY. et al. Is Liver-Specific Gadoxetic Acid-Enhanced Magnetic Resonance Imaging a Reliable Tool for Detection of Hepatocellular Carcinoma in Patients with Chronic Liver Disease?. Dig Dis Sci 58, 3313–3325 (2013). https://doi.org/10.1007/s10620-013-2790-y

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