Comparative 13-year meta-analysis of the sensitivity and positive predictive value of ultrasound, CT, and MRI for detecting hepatocellular carcinoma
- 29 December 2015
- journal article
- research article
- Published by Springer Science and Business Media LLC in Abdominal Radiology
- Vol. 41 (1), 71-90
- https://doi.org/10.1007/s00261-015-0592-8
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.Keywords
Funding Information
- Fonds de Recherche du Québec - Santé (CA) (26993)
This publication has 24 references indexed in Scilit:
- QUADAS-2: A Revised Tool for the Quality Assessment of Diagnostic Accuracy StudiesAnnals of Internal Medicine, 2011
- Management of hepatocellular carcinoma: An updateJournal of Hepatology, 2011
- Double-Contrast MRI for Accurate Staging of Hepatocellular Carcinoma in Patients with CirrhosisAmerican Journal of Roentgenology, 2008
- Optimizing staging for hepatocellular carcinoma before liver transplantation: A retrospective analysis of the UNOS/OPTN databaseLiver Transplantation, 2006
- Does Screening or Surveillance for Primary Hepatocellular Carcinoma with Ultrasonography Improve the Prognosis of Patients?The Cancer Journal, 2004
- Systematic review of radiological imaging for hepatocellular carcinoma in cirrhotic patientsThe British Journal of Radiology, 2004
- Impact of pretransplant diagnosis of hepatocellular carcinoma on cadveric liver allocation in the era of MELDLiver Transplantation, 2004
- MRI angiography is superior to helical CT for detection of HCC prior to liver transplantation: An explant correlationJournal of Hepatology, 2003
- Histological grading and staging of chronic hepatitisJournal of Hepatology, 1995
- Better Bootstrap Confidence IntervalsJournal of the American Statistical Association, 1987