Combined Application of Gadoxetic Acid Disodium-Enhanced Magnetic Resonance Imaging (MRI) and Diffusion-Weighted Imaging (DWI) in the Diagnosis of Chronic Liver Disease-Induced Hepatocellular Carcinoma: A Meta-Analysis

ObjectiveGadoxetic acid disodium (Gd-EOB-DTPA) is a magnetic resonance imaging (MRI) contrast agent to target the liver cells with normal function. In clinical practice, the Gd-EOB-DTPA produces high quality hepatocyte specific image 20 minutes after intravenous injection, so DWI sequence is often performed after the conventional dynamic scanning. However, there are still some disputes about whether DWI sequence will provide more effective diagnostic information in clinical practice. This study aimed to explore the diagnostic value of combining Gd-EOB-DTPA-enhanced MRI and DWI in the detection of hepatocellular carcinoma (HCC) in patients with chronic liver disease.MethodsA systematic literature search was performed in the PubMed and Cochrane library database up to March 2015. The quality assessment of diagnostic accuracy studies (QUADAS) was used to evaluate the quality of studies. Heterogeneous test on the included literature was performed by using the software Review Manager 5.3. The MetaDiSc 1.4 software was used to calculate the pooled sensitivity, specificity, positive likelihood ratio and negative likelihood ratio; meanwhile the summary receiver operating characteristics (SROC) curve was drawn to compare the diagnostic performance.ResultsA total of 13 literatures were included in this study. In 8 literatures regarding HCC diagnosis based on Gd-EOB-DTPA-enhanced MRI, the pooled sensitivity: 0.90 (95% confidence interval (CI): 0.88–0.93); specificity: 0.89 (95% CI: 0.85–0.92); positive likelihood ratio: 8.60 (95% CI: 6.20–11.92); negative likelihood ratio: 0.10 (95% CI: 0.08–0.14) were obtained. The area under curve (AUC) and Q values were 0.96 and 0.90, respectively. In 5 literatures relating to HCC diagnosis by combination of Gd-EOB-DTPA-enhanced MRI and DWI sequence, the pooled sensitivity: 0.88 (95% CI: 0.85–0.91), specificity: 0.96 (0.94–0.97), positive likelihood ratio: 19.63 (12.77–30.16), negative likelihood ratio: 0.10 (0.07–0.14) were obtained. The AUC value was 0.9833 and Q value was 0.9436. The AUC value of comprehensive evaluation method was significantly higher than that of Gd-EOB-DTPA-enhanced MRI alone(PConclusionCombination of Gd-EOB-DTPA-enhanced MRI and DWI sequence significantly improves in both the diagnostic accuracy and specificity of chronic liver disease-associated HCC.### 研究目标 钆塞酸二钠 (Gd-EOB-DTPA) 是一类靶向正常功能肝细胞的磁共振成像 (MRI) 对比剂。临床实践中，Gd-EOB-DTPA于静脉注射20分钟后可生成高质量的肝细胞特异性影像，因此临床通常在常规动态扫描后开展弥散加权成像 (DWI) 序列扫描。但目前针对DWI序列是否能为临床提供更有效的诊断信息仍存在诸多争议。本研究旨在探讨联合Gd-EOB-DTPA增强MRI与DWI序列，对慢性肝病患者肝细胞癌 (HCC) 的诊断价值。 ### 研究方法 本研究于2015年3月前，在PubMed及Cochrane图书馆数据库中开展系统性文献检索。采用诊断准确性研究质量评价量表 (QUADAS) 对纳入研究的质量进行评估。使用Review Manager 5.3软件对纳入文献进行异质性检验。采用MetaDiSc 1.4软件计算合并灵敏度、合并特异度、合并阳性似然比及合并阴性似然比；同时绘制综合受试者工作特征 (SROC) 曲线，以比较不同诊断方法的诊断效能。 ### 研究结果 本研究共纳入13篇相关文献。其中8篇关于Gd-EOB-DTPA增强MRI单独诊断HCC的研究，其合并灵敏度为0.90（95%置信区间 (CI)：0.88–0.93），合并特异度为0.89（95% CI：0.85–0.92），合并阳性似然比为8.60（95% CI：6.20–11.92），合并阴性似然比为0.10（95% CI：0.08–0.14）；曲线下面积 (AUC) 及Q值分别为0.96与0.90。针对5篇联合Gd-EOB-DTPA增强MRI与DWI序列诊断HCC的研究，其合并灵敏度为0.88（95% CI：0.85–0.91），合并特异度为0.96（95% CI：0.94–0.97），合并阳性似然比为19.63（95% CI：12.77–30.16），合并阴性似然比为0.10（95% CI：0.07–0.14）；曲线下面积为0.9833，Q值为0.9436。联合诊断方法的曲线下面积显著高于单纯Gd-EOB-DTPA增强MRI (P ### 研究结论 联合Gd-EOB-DTPA增强MRI与DWI序列，可显著提升慢性肝病相关HCC的诊断准确度与特异度。