Background/purpose: Conflicting results have been reported between the use of extracellular contrast agent (ECA) and hepatobiliary contrast agent (HBA) when magnetic resonance imaging (MRI) is used for the diagnosis of hepatocellular carcinoma (HCC). Therefore, we aimed to compare the diagnostic performance of MRI using ECA (ECA-MRI) and HBA (HBA-MRI).
Methods: Original studies reporting the diagnostic performance of contrast-enhanced MRI for the diagnosis of HCC published between January 2010 and February 2020 were identified in a Pubmed, EMBASE, and Cochrane Library database search. The pooled sensitivity and specificity of ECA-MRI and HBA-MRI were calculated using a bivariate random effects model and compared using a joint-model bivariate meta-regression. Subgroup analyses were performed to compare the diagnostic performance of ECA-MRI and HBA-MRI according to study design, underlying liver disease, lesion size, reference standard, and imaging criteria.
Results: Of the 1760 screened articles, 31 studies were included: 15 studies included 2890 lesions imaged using ECA-MRI and 19 studies included 3893 lesions imaged using HBA-MRI. The pooled sensitivity and specificity were not significantly different between ECA-MRI (sensitivity, 72% [95% confidence interval 65-79%]; specificity 92% [89-95%]) and HBA-MRI (76% [68-83%]; 92% [87-95%], p = 0.72). Subgroup analyses did not find differences in diagnostic performance between ECA-MRI and HBA-MRI according to study design (p ≥ 0.11), underlying disease (p ≥ 0.09), lesion size (≤ 2 cm, p = 0.97), reference standard (p = 0.70), or imaging criteria (p = 0.33).
Conclusion: ECA-MRI showed similar performance to HBA-MRI in the diagnosis of HCC. The contrast agent might be selected with consideration of the advantages of each agent.
Keywords: Contrast agent; Diagnostic performance; Extracellular contrast agent; Hepatobiliary contrast agent; Hepatocellular carcinoma; Liver; Liver cancer; Magnetic resonance imaging; Meta-analysis; Systematic review.