Detection of hepatic metastases from cancers of the gastrointestinal tract by using noninvasive imaging methods (US, CT, MR imaging, PET): a meta-analysis.
OBJECTIVE
To perform a meta-analysis to compare current noninvasive imaging methods (ultrasonography [US], computed tomography [CT], magnetic resonance [MR] imaging, and (18)F fluorodeoxyglucose [FDG] positron emission tomography [PET]) in the detection of hepatic metastases from colorectal, gastric, and esophageal cancers.


METHODS
A MEDLINE literature search and review of article bibliographies and our institutional charts of patients with colorectal cancer identified data with histopathologic correlation or at least 6 months of patient follow-up. Two authors independently abstracted data sets and excluded data without contingency tables or data published more than once. Summary-weighted estimates of sensitivity were obtained and stratified according to specificity of less than 85% or 85% and higher. A covariate analysis was used to evaluate the influence of patient- or study-related factors on sensitivity.


RESULTS
Among 111 data sets, nine US (509 patients), 25 CT (1,747 patients), 11 MR imaging (401 patients), and nine PET (423 patients) data sets met the inclusion criteria. In studies with a specificity higher than 85%, the mean weighted sensitivity was 55% (95% CI: 41, 68) for US, 72% (95% CI: 63, 80) for CT, 76% (95% CI: 57, 91) for MR imaging, and 90% (95% CI: 80, 97) for FDG PET. Results of pairwise comparison between imaging modalities demonstrated a greater sensitivity of FDG PET than US (P =.001), CT (P =.017), and MR imaging (P =.055).


CONCLUSIONS
At equivalent specificity, FDG PET is the most sensitive noninvasive imaging modality for the diagnosis of hepatic metastases from colorectal, gastric, and esophageal cancers.
Department of Radiology, Geneva University Hospital, Rue Micheli-du-Crest 24, Switzerland. karen.kinkel@hcuge.ch
Karen
K
Kinkel
Ying
Y
Lu
Marcus
M
Both
Robert S
RS
Warren
Ruedi F
RF
Thoeni
D015179:Colorectal Neoplasms / Q000473:pathology; D004938:Esophageal Neoplasms / Q000473:pathology; D005770:Gastrointestinal Neoplasms / Q000473:pathology*; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000556:secondary*; D008279:Magnetic Resonance Imaging; D012680:Sensitivity and Specificity; D013274:Stomach Neoplasms / Q000473:pathology; D014055:Tomography, Emission-Computed; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography