Diagnostic value of DWI combined enhanced MRI for small hepatocellular carcinoma in patients with cirrhosis: a Meta-analysis

Abstract

Objective To perform a meta-analysis to evaluate the value of diffusion weighted imaging (DWI) combined with enhanced MRI for the diagnosis of small hepatocellular carcinoma in patients with liver cirrhosis. Methods Articles published over the period of January 2000 to December 2017 were retrieved through the systematic search of PubMed, Web of Science, China National Knowledge Infrastructure, Wanfang, and VIP databases in accordance with inclusion and exclusion criteria. The quality of the included publications was evaluated by using tools for diagnostic accuracy studies. Statistical analysis was performed by using Meta Disc 1.4 and Stata 12.0 software. The heterogeneity of the diagnostic odds ratio(DOR) of each study was tested through the χ2 test and assessed by using the I2 value. The presence of the threshold effect in each included study was tested by using the summary receiver operating characteristic(SROC) curve and the Spearman correlation coefficient. A suitable effect model for evaluating the accuracy of DWI combined with enhanced MRI for the diagnosis of small hepatocellular carcinoma in patients with liver cirrhosis was selected on the basis of the heterogeneity detection results obtained by calculating pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, DOR, and the area under the SROC. Results Seven studies and 1112 lesions were included in the analysis. The heterogeneity was 76.6%, which indicated that there was a high degree of heterogeneity in the included literature. The Spearman test showed thatr= -0.14(P=0.76), which indicated that there was no heterogeneity caused by threshold effect. Pooled sensitivity and specificity, positive likeliheod ratio, negative likelihood ratio, and DOR were 0.90(95% CI 0.88- 0.92), 0.90(95% CI 0.86- 0.93), 7.09(95% CI 3.40–14.80), 0.13(95% CI 0.08- 0.21), and 64.15(95% CI 24.22–169.88), respectively. The area under the SROC was 0.95. Conclusions DWI combined with enhanced MRI demonstrated high sensitivity and specificity in the diagnosis of small hepatocellular carcinoma in patients with cirrhosis. It can provide important evidence for the early diagnosis and treatment of small hepatocellular carcinoma in patients with cirrhosis. Key words: Carcinoma, hepatocellular; Diffusion magnetic resonance imaging; Liver cirrhosis; Meta-analysis