title: A pooled analysis of diffusion-weighted imaging in the diagnosis of hepatocellular carcinoma in chronic liver diseases.
abstract: OBJECTIVE
  The purpose of this study was to perform a meta-analysis of all available studies of the diagnostic performance of diffusion-weighted imaging (DWI) in the detection of hepatocellular carcinoma (HCC) in patients with chronic liver disease.
  
  
  METHODS
  Databases including MEDLINE and EMBASE were searched for relevant original articles published from January 2000 to April 2012. Pooled estimation and subgroup analysis data were obtained by statistical analysis.
  
  
  RESULTS
  Across the nine studies (476 patients), DWI sensitivity was 81% (95%CI: 67%-90%), and specificity was 89% (95% CI: 76%-95%). Overall, positive likelihood ratio was 7.11 (95%CI: 3.50, 14.48), negative likelihood ratio was 0.21 (95%CI: 0.12-0.37), and the diagnostic odds ratio (DOR) was 33.48 (95%CI: 16.67-67.25). The area under the curve of the summary receiver operator characteristic (ROC) was 0.92 (95% CI:0.89-0.94). In studies in which both DWI and conventional contrast-enhanced magnetic resonance imaging (CE-MRI) were performed, the comparison of DWI performance with that of conventional CE-MRI suggested no major differences against these two methods (P > 0.05). DWI combined CE-MRI had higher pooled sensitivity than DWI alone (93% vs 73%) (P < 0.05).
  
  
  CONCLUSIONS
  DWI has good diagnostic performance in the detection of HCC in patients with chronic liver disease and equivalent to conventional CE-MRI. Combination of CE-MRI and DWI can improve the diagnostic accuracy of MRI. Further larger prospective studies are still needed to establish its value for detecting HCC in patients with chronic liver disease.
authors.affiliation: Department of Radiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Lian-Ming
authors.initials: LM
authors.lastname: Wu
authors.forename: Jian-Rong
authors.initials: JR
authors.lastname: Xu
authors.forename: Qing
authors.initials: Q
authors.lastname: Lu
authors.forename: Jia
authors.initials: J
authors.lastname: Hua
authors.forename: Jie
authors.initials: J
authors.lastname: Chen
authors.forename: Jiani
authors.initials: J
authors.lastname: Hu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis* / Q000473:pathology; D003287:Contrast Media; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006801:Humans; D016013:Likelihood Functions; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D012372:ROC Curve; D055815:Young Adult
chemical_list: D003287:Contrast Media