Liver Fibrosis Staging with Gadolinium Ethoxybenzyl Diethylenetriamine Penta-Acetic Acid-enhanced: A Systematic Review and Meta-analysis

Abstract

Objective: While liver biopsy is the golden standard for liver-fibrosis diagnosis, it’s also invasive and has many limitations. Non-invasive techniques such as magnetic resonance imaging (MRI) need to be further developed for liver fibrosis staging. This study aimed to evaluate the diagnostic accuracy of gadolinium ethoxybenzyl diethylenetriamine penta-acetic acid (Gd-EOB-DTPA)-enhanced MRI for liver fibrosis through systematic review and meta-analysis. Methods: This study comprehensively searched relevant article in PubMed, Embase, and the Cochrane Library published from 2004 to 2018 to find studies analyzing the diagnostic accuracy of Gd-EOB-DTPA-enhanced MRI for liver fibrosis. Two reviewers independently screened the retrieved articles, extracted the required data from the included studies, and evaluated the methodological quality of the studies. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, and summary receiver operating characteristics (SROC) curve were assessed. Results: This study finally included 16 studies (n = 1,599) and selected a random-effects model based on the results of the I 2 statistic to combine them. The areas under the SROC curve for the detection of F1 or greater, F2 or greater, F3 or greater, or F4 liver fibrosis were 0.8669, 0.8399, 0.8481, and 0.8858, respectively. Conclusion: Gd-EOB-DTPA-enhanced MRI showed a good diagnostic performance for staging liver fibrosis, especially for F4 liver fibrosis.

Gadoxetic Acid–Enhanced Liver MRI

“…54 Meta-analyses of the effectiveness of GA-MRI for liver fibrosis staging reported the following pooled sensitivities and specificities (respectively): 0.58-0.77 and 0.82-0.95 (area under the receiver operating characteristic curve [AUROC], 0.85-0.89) for mild fibrosis (F ≥ 1); 0.57-0.72 and 0.68-0.84 (AUROC, 0.76-0.86) for moderate fibrosis (F ≥ 2); 0.61-0.80 and 0.75-0.91 (AUROC, 0.72-0.94) for severe fibrosis (F ≥ 3); and 0.77-0.86 and 0.77-0.82 (AUROC, 0.88-0.89) for cirrhosis (F4). [55][56][57] Moreover, GA-MRI can quantitatively evaluate liver function. 58 Functional liver imaging score (FLIS) is used to assess liver function.…”

“…T1 relaxation time increases owing to an elevation in the extracellular fluid of the liver (a consequence of fibrosis and inflammation) 54 . Meta-analyses of the effectiveness of GA-MRI for liver fibrosis staging reported the following pooled sensitivities and specificities (respectively): 0.58–0.77 and 0.82–0.95 (area under the receiver operating characteristic curve [AUROC], 0.85–0.89) for mild fibrosis (F ≥ 1); 0.57–0.72 and 0.68–0.84 (AUROC, 0.76–0.86) for moderate fibrosis (F ≥ 2); 0.61–0.80 and 0.75–0.91 (AUROC, 0.72–0.94) for severe fibrosis (F ≥ 3); and 0.77–0.86 and 0.77–0.82 (AUROC, 0.88–0.89) for cirrhosis (F4) 55–57 …”