A pooled analysis of diffusion-weighted imaging in the diagnosis of hepatocellular carcinoma in chronic liver diseases

Abstract

Background and aim: The purpose of this study was to perform a meta-analysis of all available studies of the diagnostic performance of diffusion-weighted imaging (DWI) in the detection of hepatocellular carcinoma (HCC) in patients with chronic liver disease.

Methods: Databases including MEDLINE and EMBASE were searched for relevant original articles published from January 2000 to April 2012. Pooled estimation and subgroup analysis data were obtained by statistical analysis.

Results: Across the nine studies (476 patients), DWI sensitivity was 81% (95%CI: 67%-90%), and specificity was 89% (95% CI: 76%-95%). Overall, positive likelihood ratio was 7.11 (95%CI: 3.50, 14.48), negative likelihood ratio was 0.21 (95%CI: 0.12-0.37), and the diagnostic odds ratio (DOR) was 33.48 (95%CI: 16.67-67.25). The area under the curve of the summary receiver operator characteristic (ROC) was 0.92 (95% CI:0.89-0.94). In studies in which both DWI and conventional contrast-enhanced magnetic resonance imaging (CE-MRI) were performed, the comparison of DWI performance with that of conventional CE-MRI suggested no major differences against these two methods (P > 0.05). DWI combined CE-MRI had higher pooled sensitivity than DWI alone (93% vs 73%) (P < 0.05).

Conclusion: DWI has good diagnostic performance in the detection of HCC in patients with chronic liver disease and equivalent to conventional CE-MRI. Combination of CE-MRI and DWI can improve the diagnostic accuracy of MRI. Further larger prospective studies are still needed to establish its value for detecting HCC in patients with chronic liver disease.