非对比 MRI 具有中等阴性 LR 和高特异性，对 HCC 的检测具有可接受的敏感性，即使在肝硬化和病变 <2 cm 的患者中也是如此。有必要进行前瞻性试验来验证非对比 MRI 是否可用于 HCC 监测。 作者: StephenW 时间: 2022-1-4 17:28
Noncontrast MRI for Diagnosis of Hepatocellular Carcinoma
Clinical Gastroenterology and Hepatology
TAKE-HOME MESSAGE
This meta-analysis of 22 studies looked at the diagnostic performance of non-contrast magnetic resonance imaging (NC-MRI) for detection of hepatocellular carcinoma (HCC). The analysis included 1685 patients and 2128 lesions. The pooled per-patient sensitivity of multi-sequence NC-MRI using T2+DW±T1 sequences was 86.8%. The specificity of this technique was 90.3%, and it had a negative likelihood ratio of 0.17. The pooled sensitivity, specificity, and negative likelihood ratio of DW-only MRI were 79.2%, 96.5%, and 0.24, respectively. In patients with cirrhosis, the sensitivity and specificity of NC-MRI were 87.3% and 81.6% and of DW-MRI were 71.4% and 97.1%, respectively. The sensitivity for lesions smaller and larger than 2 cm was 77.1% and 88.5%, respectively.
NC-MRI has a high sensitivity and an acceptable negative likelihood ratio of HCC detection, even when patients have cirrhosis or lesions smaller than than 2 cm. Further prospective trials should be carried out.
abstract
This abstract is available on the publisher's site.
BACKGROUND AND AIMS
This meta-analysis investigates the diagnostic performance of non-contrast magnetic resonance imaging (MRI) for the detection of hepatocellular carcinoma (HCC).
METHODS
A systematic review was performed to May 2020 for studies which examined the diagnostic performance of non-contrast MRI (multi-sequence or diffusion-weighted imaging (DWI)- alone) for HCC detection in high risk patients. The primary outcome was accuracy for the detection of HCC. Random effects models were used to pool outcomes for sensitivity, specificity, positive likelihood ratio (LR) and negative LR. Subgroup analyses for cirrhosis and size of the lesion were performed.
RESULTS
Twenty-two studies were included involving 1685 patients for per-patient analysis and 2128 lesions for per-lesion analysis. Multi-sequence non-contrast MRI (NC-MRI) using T2+DWI±T1 sequences had a pooled per-patient sensitivity of 86.8% (95%CI:83.9-89.4%), specificity of 90.3% (95%CI:87.3-92.7%), and negative LR of 0.17 (95%CI:0.14-0.20). DWI-only MRI (DW-MRI) had a pooled sensitivity of 79.2% (95%CI:71.8-85.4%), specificity of 96.5% (95%CI:94.3-98.1%) and negative LR of 0.24 (95%CI:1.62-0.34). In patients with cirrhosis, NC-MRI had a pooled per-patient sensitivity of 87.3% (95%CI:82.7-91.0%) and specificity of 81.6% (95%CI:75.3-86.8%), whilst DWI-MRI had a pooled sensitivity of 71.4% (95%CI:60.5-80.8%) and specificity of 97.1% (95%CI:91.9-99.4%). For lesions <2 cm, the pooled per-lesion sensitivity was 77.1% (95%CI:73.8-80.2%). For lesions >2 cm, pooled per-lesion sensitivity was 88.5% (95%CI:85.0-91.5%).
CONCLUSION
Non-contrast MRI has a moderate negative LR and high specificity with acceptable sensitivity for the detection of HCC, even in patients with cirrhosis and with lesions <2 cm. Prospective trials to validate if non-contrast MRI can be used for HCC surveillance is warranted.