非对比 MRI 诊断肝细胞癌

StephenW

非对比 MRI 诊断肝细胞癌

临床胃肠病学和肝病学

带回家的消息

    这项对 22 项研究的荟萃分析着眼于非对比磁共振成像 (NC-MRI) 检测肝细胞癌 (HCC) 的诊断性能。分析包括 1685 名患者和 2128 个病灶。使用 T2+DW±T1 序列的多序列 NC-MRI 的每名患者汇总敏感性为 86.8%。该技术的特异性为 90.3%，阴性似然比为 0.17。 DW-only MRI 的汇总敏感性、特异性和阴性似然比分别为 79.2%、96.5% 和 0.24。在肝硬化患者中，NC-MRI 的敏感性和特异性分别为 87.3% 和 81.6%，DW-MRI 的敏感性和特异性分别为 71.4% 和 97.1%。对小于和大于 2 cm 病灶的敏感性分别为 77.1% 和 88.5%。

    NC-MRI 具有高灵敏度和可接受的 HCC 检测阴性似然比，即使患者患有肝硬化或病变小于 2 cm。应进行进一步的前瞻性试验。

抽象的

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背景和目标

这项荟萃分析调查了非对比磁共振成像 (MRI) 在检测肝细胞癌 (HCC) 方面的诊断性能。
方法

一项系统回顾已于 2020 年 5 月进行，这些研究检查了非对比 MRI（单独的多序列或弥散加权成像 (DWI)）在高危患者中检测 HCC 的诊断性能。主要结果是检测 HCC 的准确性。随机效应模型用于汇总敏感性、特异性、阳性似然比 (LR) 和阴性 LR 的结果。对肝硬化和病变大小进行亚组分析。
结果

纳入了 22 项研究，涉及 1685 名患者进行每个患者分析，2128 个病变用于每个病灶分析。使用 T2+DWI±T1 序列的多序列非对比 MRI (NC-MRI) 具有 86.8% (95%CI:83.9-89.4%) 的汇总每位患者敏感性，90.3% (95%CI:87.3) 的特异性-92.7%)，负 LR 为 0.17 (95%CI:0.14-0.20)。仅 DWI MRI (DW-MRI) 的汇总敏感性为 79.2% (95%CI:71.8-85.4%)，特异性为 96.5% (95%CI:94.3-98.1%)，阴性 LR 为 0.24 (95%CI) :1.62-0.34)。在肝硬化患者中，NC-MRI 具有 87.3% (95%CI:82.7-91.0%) 的汇总敏感性和 81.6% (95%CI:75.3-86.8%) 的特异性，而 DWI-MRI 具有汇总敏感性为 71.4% (95%CI:60.5-80.8%)，特异性为 97.1% (95%CI:91.9-99.4%)。对于 <2 cm 的病灶，每个病灶的汇总敏感性为 77.1% (95% CI:73.8-80.2%)。对于 >2 cm 的病灶，每个病灶的汇总敏感性为 88.5% (95%CI:85.0-91.5%)。
结论

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。

StephenW

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.