Comparative 13-year meta-analysis of the sensitivity and positive predictive value of ultrasound, CT, and MRI for detecting hepatocellular carcinoma
Comparative 13-year meta-analysis of the sensitivity and positive predictive value of ultrasound, CT, and MRI for detecting hepatocellular carcinoma
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DOI：
10.1007/s00261-015-0592-8
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发表时间：
2016-01-01
影响因子：
2.4
通讯作者：
Sirlin, Claude B.
中科院分区：
文献类型：
--
作者：
Hanna, Robert F.;Miloushev, Vesselin Z.;Sirlin, Claude B.
目的：比较超声（US）、计算机断层扫描（CT）和磁共振成像（MRI）诊断肝细胞癌（HCC）的每病灶敏感性和阳性预测值（PPV）。材料和方法：敏感性荟萃分析纳入242项研究（15，713例患者）; 116项研究（7492例患者）允许计算PPV。结果：对比增强CT（73.6%，85.8%）和钆增强MRI（77.5%，83.6%）的合并病灶敏感性和PPV无显著差异（P = 0.08，P = 0.2）。然而，如果使用肝胆药物钆塞酸盐，MRI的合并每病变灵敏度和PPV（85.6%，94.2%）显著高于CT（P < 0.0001）或MRI与其他药物（P < 0.0001）。非增强超声的总体敏感性和PPV最低（59.3%，77.4%）。合并每病变的敏感性和PPV的对比增强US（84.4%，89.3%）是相对较高的，但没有对比增强US研究使用最严格的参考standards.Conclusion：MRI利用肝胆剂钆塞酸盐具有最高的整体敏感性和PPV，并可能是诊断HCC的单一最佳方法。非对比增强超声的敏感性和PPV最低。需要更严格的参考标准来比较对比增强US与CT和MRI的性能。CT和常规钆增强MRI之间的灵敏度和PPV差异总体上没有统计学意义。
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 gadoliniumenhanced 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.