Abstract
Simple SummaryUltrasonography is recommended as a standard surveillance modality, but the performance of surveillance ultrasound for detecting early-stage hepatocellular carcinoma (HCC) is limited. Motivated to provide a more sensitive method, abbreviated magnetic resonance imaging (AMRI) protocols have been introduced for HCC surveillance. We aimed to systematically determine the diagnostic performance of surveillance AMRI for detecting HCC. This meta-analysis of 10 studies comprising 1547 patients found that the pooled sensitivity and specificity of surveillance AMRI for detecting HCC were 86% and 96%, respectively. Hepatobiliary phase contrast-enhanced AMRI showed significantly higher sensitivities for detecting HCC than non-contrast AMRI (87% vs. 82%), but significantly lower specificities (93% vs. 98%). Therefore, surveillance AMRI had overall good diagnostic performance for detecting HCC and might be clinically useful for HCC surveillance. In addition, AMRI protocol should be selected with consideration of the advantages and disadvantages of each protocol.We aimed to determine the performance of surveillance abbreviated magnetic resonance imaging (AMRI) for detecting hepatocellular carcinoma (HCC), and to compare the performance of surveillance AMRI according to different protocols. Original research studies reporting the performance of surveillance AMRI for the detection of HCC were identified in MEDLINE, EMBASE, and Cochrane databases. The pooled sensitivity and specificity of surveillance AMRI were calculated using a hierarchical model. The pooled sensitivity and specificity of contrast-enhanced hepatobiliary phase (HBP)-AMRI and non-contrast (NC)-AMRI were calculated and compared using bivariate meta-regression. Ten studies, including 1547 patients, reported the accuracy of surveillance AMRI. The pooled sensitivity and specificity of surveillance AMRI for detecting any-stage HCC were 86% (95% confidence interval (CI), 80–90%; I2 = 0%) and 96% (95% CI, 93–98%; I2 = 80.5%), respectively. HBP-AMRI showed a significantly higher sensitivity for detecting HCC than NC-AMRI (87% vs. 82%), but significantly lower specificity (93% vs. 98%) (p = 0.03). Study quality and MRI magnet field strength were factors significantly associated with study heterogeneity (p ≤ 0.01). In conclusion, surveillance AMRI showed good overall diagnostic performance for detecting HCC. HBP-AMRI had significantly higher sensitivity for detecting HCC than NC-AMRI, but lower specificity.
Highlights
Hepatocellular carcinoma (HCC) is the third most leading cause of cancer-related deaths [1], and the incidence of HCC in North America and Europe has risen rapidly over the last 2 decades [2]
Our meta-analysis showed that surveillance abbreviated magnetic resonance imaging (AMRI) had a good overall diagnostic performance for detecting HCC, with pooled sensitivities for detection of any-stage and early-stage HCC of 86% and 81%, respectively
We found that surveillance AMRI showed a high sensitivity for any-stage and earlystage HCC, without statistical heterogeneity across the studies (I2 for sensitivity = 0%)
Summary
Hepatocellular carcinoma (HCC) is the third most leading cause of cancer-related deaths [1], and the incidence of HCC in North America and Europe has risen rapidly over the last 2 decades [2]. The sensitivity of US for detecting early-stage HCC is not high (47%) [8] Given this limitation of US surveillance, the recent guidelines suggest alternative surveillance tools, including magnetic resonance imaging (MRI), in selected patients with a high probability of having an inadequate US examination [5,6]. Recent studies showed that surveillance MRI had a higher sensitivity than US for detecting early-stage HCC [9], and it might be more cost-effective than US in patients with virus-associated compensated cirrhosis with a sufficiently high risk of HCC [10]. Due to its cost, the long exam time, and complexity, the broad application of complete MRI with full sequences is likely to remain limited in a surveillance setting. Our study aimed to determine the performance of surveillance AMRI for detecting HCC, and to compare the performance according to different protocols
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