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Diagnostic accuracy of quantitative diffusion parameters in the pathological grading of hepatocellular carcinoma: A
Dawei Yang1, Hualong She2, Xiaopei Wang1
1Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
Background:
Accurate preoperative assessment of the pathological grade of hepatocellular carcinoma (HCC) could greatly benefit prognostic predictions.
Purpose:
To assess and compare the diagnostic accuracy of the apparent diffusion coefficient (ADC) and tissue diffusivity (D) for the noninvasive pathological grading of HCC.
Study Type:
Meta-analysis.
Data Sources:
PubMed/Medline, EMBASE, the Web of Science, and the Cochrane Library were searched to find related original articles published up to May 30, 2019.
Field Strength/Sequence:
Diffusion-weighted imaging (DWI) and/or intravoxel incoherent motion (IVIM) were performed with a 1.5T or 3.0T scanner.
Assessment:
The Quality Assessment of Diagnostic Accuracy Studies 2 tool was used to assess the methodologic quality.
Statistical Tests:
The bivariate random-effects model was used to obtain the pooled sensitivity and specificity, and the area under summary receiver operating characteristic curve (AUROC) was obtained. Subgroup analyses were performed.
Results:
A total of 16 original articles (1428 HCCs) were included. Most studies had a low to unclear risk of bias and minimal concerns regarding applicability. For the discrimination of well-differentiated HCCs, the pooled sensitivity and specificity of the ADC value were 85% and 92%, respectively. For the discrimination of poorly differentiated HCCs, the pooled sensitivity and specificity of the ADC value and D were 84% and 80%, and 92% and 77%, respectively. The summary AUROC of D (0.94) was significantly higher than that of ADC (0.89) (z = -2.718, P = 0.007). The subgroup analyses identified three covariates including size, number of included lesions in the studies, and blindness to the reference standard as possible sources of heterogeneity.
Data Conclusion:
This meta-analysis showed that the ADC and D values had a high to excellent accuracy for the noninvasive pathological grading of HCCs and that the D value was superior to the ADC value for discriminating poorly differentiated HCCs.
Level Of Evidence:
3 Technical Efficacy Stage: 2 J. Magn. Reson. Imaging 2020;51:1581-1593.
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