Diagnostic Efficacy of Contrast‐Enhanced MRI in Detecting Residual or Recurrent Hepatocellular Carcinoma After Transarterial Chemoembolization: A Systematic Review and Meta‐analysis

Abstract

Background The diagnostic efficacy of contrast‐enhanced magnetic resonance imaging (CEMRI) in diagnosing residual or recurrent hepatocellular carcinoma (HCC) after transarterial chemoembolization (TACE) is currently not completely clear. Purpose To investigate the diagnostic efficacy of CEMRI in detecting residual or recurrent HCCs after TACE by meta‐analysis. Study Type Systematic review and meta‐analysis. Population A systematic literature search was performed in PubMed, Embase, Web of Science, Ovid, and the Cochrane Library database up to June 2019 to find original studies on diagnosing patients suspected of residual or recurrent HCCs after TACE with CEMRI. Thirteen studies comprising 721 nodules were finally included. Field Strength/Sequence 1.5T or 3.0T, CEMRI. Assessment Quality assessment of the included studies was performed by applying the Quality Assessment of Diagnostic Accuracy Studies‐2 (QUADAS‐2) tool. Statistical Tests Sensitivity and specificity were pooled with a bivariate random‐effects model. Heterogeneity was assessed by the chi‐square test. The potential sources of heterogeneity were explored by subgroup and publication bias analyses. Results The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, and area under the summary receiver operating characteristic (ROC) curve (AUC) of CEMRI in diagnosing residual or recurrent HCCs after TACE were 91% (95% confidence interval [CI]: 87%–96%), 93% (95% CI: 85%–97%), 12.22 (95% CI: 5.62–26.57), 0.09 (95% CI: 0.05–0.18), 126.99 (95% CI: 34.76–436.99) and 0.97 (95% CI: 0.95–0.98), respectively. Subgroup analysis revealed that CEMRI performed significantly better in prospective studies than in retrospective studies: 0.99 (95% CI: 0.96–1.00) vs. 0.95 (95% CI: 0.92–0.96) with P < 0.05. Data Conclusion Our meta‐analysis suggested that CEMRI had high diagnostic efficacy in detecting residual or recurrent HCCs after TACE and may serve as an alternative method for further evaluation after TACE. Level of Evidence: 5 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2020;52:1019–1028.

Diagnostic values of contrast-enhanced MRI and contrast-enhanced CT for evaluating the response of hepatocellular carcinoma after transarterial chemoembolisation: a meta-analysis

“…The diagnostic values of CEMRI and CECT for detecting HCC after TACE have already been illustrated in previous studies 40 41. A meta-analysis by Zhong et al included 11 studies comparing the diagnostic value of contrast-enhanced ultrasonography (CEUS) and CECT for detecting HCC after TACE.…”

“…They pointed out that the sensitivity (CEUS, 0.97; CECT, 0.72) and negative predictive value (CEUS, 0.90; CECT, 0.51) of CEUS were better than those of CECT, while the specificity (CEUS, 0.86; CECT, 0.99) of CECT was higher than that of CEUS 40. Moreover, Liu et al conducted a meta-analysis of 13 studies and found that CEMRI had a relatively high diagnostic value (sensitivity: 91%; specificity: 93%; PLR: 12.22; NLR: 0.09; DOR: 126.99; AUC: 0.97) for diagnosing HCC after TACE and hence could be regarded as an alternative diagnostic method 41. However, one of the above studies reported on the diagnostic performance of CECT and CEUS, while the other reported that of CEMRI.…”

“… 40 Moreover, Liu et al conducted a meta-analysis of 13 studies and found that CEMRI had a relatively high diagnostic value (sensitivity: 91%; specificity: 93%; PLR: 12.22; NLR: 0.09; DOR: 126.99; AUC: 0.97) for diagnosing HCC after TACE and hence could be regarded as an alternative diagnostic method. 41 However, one of the above studies reported on the diagnostic performance of CECT and CEUS, while the other reported that of CEMRI.…”

“…The diagnostic values of CEMRI and CECT for detecting HCC after TACE have already been illustrated in previous studies. 40 41 A meta-analysis by Zhong et al included 11 studies comparing the diagnostic value of contrast-enhanced ultrasonography (CEUS) and CECT for detecting HCC after TACE. They pointed out that the sensitivity (CEUS, 0.97; CECT, 0.72) and negative predictive value (CEUS, 0.90; CECT, 0.51) of CEUS were better than those of CECT, while the specificity (CEUS, 0.86; CECT, 0.99) of CECT was higher than that of CEUS.…”

Editorial on “Diagnostic Efficacy of Contrast‐Enhanced MRI in Detecting Residual or Recurrent Hepatocellular Carcinoma After Transarterial Chemoembolization: A Systematic Review and Meta‐analysis”

“…MRI has emerged as the most accurate and acceptable tool for longitudinal follow‐up after TACE, although the accuracy in this high‐risk population is not well known. In this issue of JMRI, a systematic review presented by Liu et al titled "Diagnostic efficacy of contrast‐enhanced MRI in detecting residual or recurrent hepatocellular carcinoma after transarterial chemoembolization: A systematic review and meta‐analysis" provides insight into the potential of MRI for this purpose.…”