Robert F Hanna1, Vesselin Z Miloushev1, An Tang2, Lee A Finklestone1, Sidney Z Brejt1, Ranjit S Sandhu1, Cynthia S Santillan3, Tanya Wolfson4, Anthony Gamst4, Claude B Sirlin3. 1. Department of Diagnostic Radiology, Columbia University, New York Presbyterian Hospital, 622 West 168th Street, New York, NY, 10032, USA. 2. Department of Radiology, Hôpital Saint-Luc, University of Montreal, 1058 Rue Saint-Denis, Montreal, QC, H2X 3J4, Canada. an.tang@umontreal.ca. 3. Liver Imaging Group, Department of Radiology, University of California San Diego, 200 W Arbor Drive, San Diego, CA, 92103, USA. 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.
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.
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.
Authors: Ania Z Kielar; Victoria Chernyak; Mustafa R Bashir; Richard K Do; Kathryn J Fowler; Donald G Mitchell; Milena Cerny; Khaled M Elsayes; Cynthia Santillan; Aya Kamaya; Yuko Kono; Claude B Sirlin; An Tang Journal: J Magn Reson Imaging Date: 2018-04-06 Impact factor: 4.813
Authors: Saleh A Alqahtani; Faisal M Sanai; Ashwaq Alolayan; Faisal Abaalkhail; Hamad Alsuhaibani; Mazen Hassanain; Waleed Alhazzani; Abdullah Alsuhaibani; Abdullah Algarni; Alejandro Forner; Richard S Finn; Waleed K Al-Hamoudi Journal: Saudi J Gastroenterol Date: 2020-10 Impact factor: 2.485
Authors: Julie Y An; Miguel A Peña; Guilherme M Cunha; Michael T Booker; Bachir Taouli; Takeshi Yokoo; Claude B Sirlin; Kathryn J Fowler Journal: Radiographics Date: 2020 Nov-Dec Impact factor: 5.333
Authors: Andrej Lyshchik; Yuko Kono; Christoph F Dietrich; Hyun-Jung Jang; Tae Kyoung Kim; Fabio Piscaglia; Alexander Vezeridis; Juergen K Willmann; Stephanie R Wilson Journal: Abdom Radiol (NY) Date: 2018-04
Authors: Victoria Chernyak; Kathryn J Fowler; Aya Kamaya; Ania Z Kielar; Khaled M Elsayes; Mustafa R Bashir; Yuko Kono; Richard K Do; Donald G Mitchell; Amit G Singal; An Tang; Claude B Sirlin Journal: Radiology Date: 2018-09-25 Impact factor: 11.105