title: Can diffusion-weighted magnetic resonance imaging (DW-MRI) alone be used as a reliable sequence for the preoperative detection and characterisation of hepatic metastases? A meta-analysis.
abstract: OBJECTIVE
  To perform a meta-analysis of all available studies of the diagnostic performance of diffusion-weighted magnetic resonance imaging (DW-MRI) in patients with hepatic metastases.
  
  
  METHODS
  Databases including MEDLINE and EMBASE were searched for relevant original articles published from January 2000 to February 2012. We determined sensitivities and specificities across studies, calculated positive and negative likelihood ratios (LR+ and LR-), diagnostic odds ratio (DOR) and constructed summary receiver operating characteristic curves using hierarchical regression models.
  
  
  RESULTS
  Across 11 studies (537 patients), DW-MRI sensitivity was 0.87 (95%confidence interval (CI), 0.80, 0.91) and specificity was 0.90 (95%CI, 0.86, 0.93). Overall, LR+ was 8.52 (95%CI, 6.17, 11.77), LR- was 0.15 (95%CI, 0.10, 0.22) and DOR was 57.36 (95%CI, 38.29, 85.93). In studies in which both DW-MRI and contrast-enhanced magnetic resonance imaging (CE-MRI) were performed, the comparison of DW-MRI performance with that of CE-MRI suggested no major differences against these two methods (p>0.05). DW-MRI combined CE-MRI had higher sensitivity and specificity than DW-MRI alone (97% versus 86% and 91% versus 90%, respectively) (p<0.05). The subgroup in which DW-MRI examinations were performed with a 3.0 Tesla (T) device had higher pooled specificity (0.91, 95%CI, 0.88-0.95) than the subgroup of DW-MRI with 1.5 T device (0.81, 95%CI, 0.67, 0.94) (p<0.05). Average lesion size (≤ 1.5 cm versus >1.5cm) did not influence the diagnostic accuracy of the test (p>0.05).
  
  
  CONCLUSIONS
  Our results demonstrate DW-MRI has good diagnostic performance in the overall evaluation of hepatic metastases and equivalent to CE-MRI. Combination of CE-MRI and DW-MRI can improve the diagnostic accuracy of magnetic resonance (MR) imaging. Our study further confirms that DW-MRI can accurately detect hepatic metastases regardless of the lesion size. It is suggested to perform DW-MRI by 3.0 T devices, which might have high specificity to identify liver metastases.
authors.affiliation: Department of Radiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China. wlmssmu@gmail.com
authors.forename: Lian-Ming
authors.initials: LM
authors.lastname: Wu
authors.forename: Jiani
authors.initials: J
authors.lastname: Hu
authors.forename: Hai-Yan
authors.initials: HY
authors.lastname: Gu
authors.forename: Jia
authors.initials: J
authors.lastname: Hua
authors.forename: Jian-Rong
authors.initials: JR
authors.lastname: Xu
mesh_terms: D003287:Contrast Media; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D006801:Humans; D007089:Image Enhancement; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000556:secondary*; D016017:Odds Ratio; D049268:Positron-Emission Tomography; D017594:Publication Bias
chemical_list: D003287:Contrast Media