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Abbreviated MRI for Hepatocellular Carcinoma Surveillance - A Systematic Review and Meta-analysis
Soe Thiha Maung1, Natee Deepan2, Pakanat Decharatanachart2
1Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, 1873 Rama IV Road, Patumwan, Bangkok, Thailand; Ma Har Myaing Hospital, Yangon, Myanmar.
Background:
Given the limited sensitivity of ultrasound in hepatocellular carcinoma (HCC) surveillance, this systematic review and meta-analysis were aimed to assess the diagnostic performance of non-contrast abbreviated MRI (NC-aMRI) compared to contrast-enhanced abbreviated MRI (CE-aMRI) for HCC surveillance, offering evidence-based guidance for clinical decision-making.
Methods:
A comprehensive search was conducted across five databases, identifying studies on aMRI for HCC surveillance. The pooled sensitivity and specificity were estimated using a random effects model. Subgroup analyses and meta-regression were performed by study location, proportion of patients with cirrhosis and HCC, and underlying liver diseases.
Results:
The meta-analysis included 27 studies (2009-2023), distributed between Western (n = 14) and Eastern (n = 13) countries. The pooled sensitivity and specificity (95%CI, I2) were 86% (83-88%, 63%) and 92% (90%-94%, 74%). The NC-aMRI protocols reported in 21 studies exhibited 83% (79-87%, 63%) sensitivity and 91% (88-93%, 67%) specificity, while the 15 studies on CE-aMRI protocols displayed 88% (84-91%, 64%) sensitivity and 94% (90-96%, 78%) specificity, with no statistically significant differences in sensitivity (p = 0.078) or specificity (p = 0.157). Subgroup analysis in NC-aMRI studies showed significant differences in sensitivity for high-prevalent chronic hepatitis B (87% vs. 78%, p = 0.003) and studies done in eastern countries (86% vs. 76%, p = 0.018). Additionally, specificity showed significant differences for high-prevalent chronic hepatitis C (94% vs. 90%, p = 0.009), with meta-regression identifying major sources of study heterogeneity as the inclusion of a majority of patients with chronic hepatitis B (p = 0.008) and the geographic regions where studies were conducted (p = 0.030).
Conclusion:
Surveillance aMRI protocols exhibit satisfactory performance for detecting HCC. NC-aMRI may be used effectively for HCC surveillance, especially in chronic hepatitis B prevalent settings.
Insights
Non-contrast abbreviated MRI (NC-aMRI) shows comparable diagnostic performance to contrast-enhanced abbreviated MRI (CE-aMRI) for hepatocellular carcinoma (HCC) surveillance. NC-aMRI is a viable option, particularly in regions with high rates of chronic hepatitis B.
Area of Science:
- Radiology
- Oncology
- Hepatology
Background:
- Ultrasound's limited sensitivity for hepatocellular carcinoma (HCC) surveillance necessitates improved imaging techniques.
- Abbreviated MRI (aMRI) offers a potential alternative for HCC surveillance.
- Comparing non-contrast abbreviated MRI (NC-aMRI) with contrast-enhanced abbreviated MRI (CE-aMRI) is crucial for clinical decision-making.
Purpose of the Study:
- To systematically review and meta-analyze the diagnostic performance of NC-aMRI versus CE-aMRI for HCC surveillance.
- To provide evidence-based guidance for selecting appropriate imaging modalities in HCC surveillance.
Main Methods:
- A comprehensive systematic search of five databases was conducted to identify relevant studies on aMRI for HCC surveillance.
- Pooled sensitivity and specificity were calculated using a random-effects model.
- Subgroup analyses and meta-regression were performed to explore heterogeneity based on study location, patient demographics, and liver disease prevalence.
Main Results:
- The meta-analysis included 27 studies, with pooled sensitivity of 86% and specificity of 92% for aMRI.
- NC-aMRI (21 studies) showed 83% sensitivity and 91% specificity; CE-aMRI (15 studies) showed 88% sensitivity and 94% specificity.
- No statistically significant differences were found between NC-aMRI and CE-aMRI, though subgroup analyses revealed variations based on hepatitis B prevalence and geographic region.
Conclusions:
- Abbreviated MRI protocols demonstrate satisfactory performance for HCC detection.
- NC-aMRI is an effective option for HCC surveillance, especially in populations with high prevalence of chronic hepatitis B.
- Further research may refine aMRI protocols for optimal HCC surveillance across diverse patient groups.
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