Magnetic Resonance Imaging with Gadoxetic Acid Disodium for the Detection of Hepatocellular Carcinoma: A Meta-analysis of 18 Studies

Rationale and Objectives: To determine the accuracy of magnetic resonance imaging (MRI) with gadoxetic acid disodium for the detection of hepatocellular carcinoma (HOC). Materials and Methods: Various databases were searched for original articles published before May 2013. Studies were selected, which performed MRI with gadoxetic acid disodium to detect and diagnose HCC and which presented sufficient data to allow construction of contingency tables. For each study, the true-positive, false-positive, true-negative, and false-negative values were extracted or derived, and 2 x 2 contingency tables were constructed. The heterogeneity test, the threshold effect test, the publication bias analysis, and subgroup analyses were performed. Results: From 623 citations, 18 were included in the meta-analysis with a total of 2572 lesions. We detected heterogeneity between studies and evidence of publication bias. The methodological quality was moderate. The pooled weighted sensitivity was 0.91 (95% confidence interval [CI], 0.90-0.93), the specificity was 0.94 (95% CI, 0.93-0.96), the positive likelihood ratio was 12.31 (95% CI, 7.66-19.78), the negative likelihood ratio was 0.10(95% CI, 0.07-0.13), and the diagnostic odds ratio was 159.72(95% CI, 91.72-276.08). The area under the receiver operating characteristic curve was 0.98 (95% CI, 0.96-0.99). Conclusions: MRI with gadoxetic acid disodium is a noninvasive and no radiation exposure imaging modality with high sensitivity and specificity fpr the detection of HOC. Nonetheless, it should be applied cautiously in liver nodule <1 cm, and large-scale well-designed trials are necessary to assess its clinical value.