Meta-Analysis of Gadoxetic Acid Disodium (Gd-EOB-DTPA)-Enhanced Magnetic Resonance Imaging for the Detection of Liver Metastases

Lihua Chen,Chen Liu,Lin Zhang,Jing Bao,Jian Wang,Yunbao Xia,Xuequan Huang,Jiuquan Zhang,Xiaoyuan Chen

doi:10.1371/journal.pone.0048681

Abstract

ObjectiveTo determine the accuracy of MR imaging with Gd-EOB-DTPA for the detection of liver metastases.Materials and MethodsPUBMED, EMBASE, the Web of Science, and the Cochrane Library were searched for original articles published prior to February 2012. The criteria for the inclusion of articles were as follows: reported in the English language; MR imaging with Gd-EOB-DTPA was performed to detect liver metastases; histopathologic analysis (surgery, biopsy), intraoperative observation (manual palpatation, intraoperative ultrasonography), and/or follow-up US was the reference standard; and data were sufficient for the calculation of true-positive or false-negative values. The methodological quality was assessed by using the quality assessment of diagnostic studies instrument. The data were extracted to calculate sensitivity, specificity, predictive value, diagnostic odds ratio, and areas under hierarchical summary receiver operating characteristic (HSROC) curve to perform heterogeneity test and threshold effect test, as well as publication bias analysis and subgroup analyses.ResultsFrom 229 citations, 13 were included in the meta-analysis with a total of 1900 lesions. We detected heterogeneity between studies and evidence of publication bias. The methodological quality was moderate. The pooled weighted sensitivity with a corresponding 95% confidence interval (CI) was 0.93 (95% CI: 0.90, 0. 95), the specificity was 0.95 (95% CI: 0.91, 0.97), the positive likelihood ratio was 18.07 (95% CI: 10.52, 31.04), the negative likelihood ratio was 0.07 (95% CI: 0.05, 0.10), and the diagnostic odds ratio was 249.81 (95% CI: 125.12, 498.74). The area under the receiver operator characteristic curve was 0.98 (95% CI: 0.96, 0.99).ConclusionMR imaging with Gd-EOB-DTPA is a reliable, non-invasive, and no-radiation-exposure imaging modality with a high sensitivity and specificity for detection of liver metastases. Nonetheless, it should be applied cautiously, and large scale, well-designed trials are necessary to assess its clinical value.

Highlights

The liver is one of the most common sites for metastatic disease, accounting for 25% of all metastases to solid organs, and secondary liver neoplasms are far more common than primary hepatic neoplasms [1]
The pooled weighted sensitivity with a corresponding 95% confidence interval (CI) was 0.93, the specificity was 0.95, the positive likelihood ratio was 18.07, the negative likelihood ratio was 0.07, and the diagnostic odds ratio was 249.81
Selection of Articles The articles selected for inclusion met the following criteria: the articles were reported in the English language; magnetic resonance (MR) imaging with Gd-EOB-DTPA was performed to identify and characterise liver

Summary

Introduction

The liver is one of the most common sites for metastatic disease, accounting for 25% of all metastases to solid organs, and secondary liver neoplasms are far more common than primary hepatic neoplasms [1]. The accurate detection of liver metastases is crucial for determining treatment planning and for improved therapeutic outcomes. Both interventional therapies and complete resection of hepatic metastases have been shown to increase survival in patients with colorectal cancer and other selected malignancies [2,3]. About 20 minutes after injection, normal areas of the liver exhibit T1 shortening because of specific hepatocyte uptake of approximately 50% of the injected dose, whereas hepatic metastases, do not exhibit T1 shortening [4,5,6]. Combined with the three-dimensional gradient-echo sequence technique, which provides excellent spatial resolution, gadoxetate disodium–enhanced MR imaging may be useful in detecting small liver lesions [7]

Methods

Results

Discussion

Conclusion