Superparamagnetic iron oxide-enhanced magnetic resonance imaging for focal hepatic lesions: systematic review and meta-analysis

Abstract

Aim: To evaluate the performance of superparamagnetic iron oxide (SPIO)-enhanced magnetic resonance imaging (MRI) in the detection and characterization of focal hepatic lesions (FHLs).

Methods: This meta-analysis compared relevant studies that were identified by searching PubMed, EMBASE, and the Cochrane Library databases for articles published between January 1988 and September 2014 and that met the following criteria: (1) SPIO-enhanced MRI was conducted to identify FHLs and data were sufficient for pooled analysis using Meta-DiSc 1.4; (2) hepatocellular carcinomas (HCCs) were differentiated from other FHLs; (3) well-differentiated HCCs (WD-HCCs) were contradistinguished from dysplastic nodules; and (4) WD-HCCs were compared with moderately and poorly differentiated HCCs (MD- and PD-HCCs, respectively).

Results: The data obtained from 15 eligible studies yielded a sensitivity of 85% and a specificity of 78% for differentiating between HCCs and other FHLs. The sensitivity was unchanged and the specificity was increased to 87% when non-HCC malignancies were excluded. Comparative analyses between WD-HCCs and MD- and PD-HCCs from seven studies showed a sensitivity of 98% and a specificity of 50% for the diagnosis of MD- and PD-HCCs, and the area under the summary receiver operating characteristics (sROC) curve was 0.97. A comparison between WD-HCCs and dysplastic nodules revealed a sensitivity of 50% and a specificity of 92% for the diagnosis of WD-HCCs and the area under the sROC curve was 0.80.

Conclusion: SPIO-enhanced MRI is useful in differentiating between HCCs and other FHLs.

Keywords: Hepatocellular carcinomas; Magnetic resonance imaging; Meta-analysis; Other lesions; USPIO.

Figure 1

Flow chart of process used to select eligible articles.

Figure 2

Forest plots for comparing hepatocellular carcinomas with all other liver lesions. A: Sensitivity; B: Specificity of 14 studies.

Figure 3

Forest plots for comparing hepatocellular carcinomas with benign liver lesions. A: Sensitivity; B: Specificity of 14 studies.

Figure 4

Forest plots for comparing advanced hepatocellular carcinomas with well-differentiated hepatocellular carcinomas. A: Sensitivity; B: Specificity of seven studies.

Figure 5

Summary receiver operating characteristics curves. Sensitivity and specificity are plotted for studies comparing advanced hepatocellular carcinomas (HCCs) with well-differentiated HCCs (A) and well-differentiated HCCs with dysplastic nodules (B). AUC: Area under the curve; sROC: Summary receiver operating characteristics.

Figure 6

Forest plots for comparing well-differentiated hepatocellular carcinomas with dysplastic nodules. A: Sensitivity; B: Specificity of seven studies.