title: The diagnostic value of Gd-EOB-DTPA-MRI for the diagnosis of focal nodular hyperplasia: a systematic review and meta-analysis.
abstract: OBJECTIVE
  We aimed to systematically review the gadoxetic acid-enhanced magnetic resonance imaging (Gd-EOB-DTPA-MRI) findings of focal nodular hyperplasia (FNH) and its diagnostic value.
  
  
  METHODS
  A thorough literature search was conducted in Ovid-MEDLINE and EMBASE databases to identify studies evaluating Gd-EOB-DTPA-MRI findings of FNH. To evaluate the frequency of characteristic imaging findings on Gd-EOB-DTPA-MRI, pooled proportions of high/iso signal intensity (SI) on the hepatobiliary phase (HBP), arterial enhancement, high/iso SI on the portal-venous phase (PVP) or equilibrium phase (EP), and the central scar were calculated. Meta-analysis was performed to evaluate the diagnostic accuracy of high/iso SI on HBP for distinguishing FNH from hepatocellular adenoma.
  
  
  RESULTS
  A review of 96 articles identified ten eligible articles with 304 patients with FNHs for meta-analysis. Pooled proportion of the Gd-EOB-DTPA-MRI findings showed that high/iso SI on the HBP, arterial enhancement, and high/iso SI on the PVP/EP were observed in 93% (95% CI, 90-97%), 99% (95% CI, 97-100%), and 97% (95% CI, 95-99%) of FNHs, respectively, while a central scar was observed in 61% of FNHs (95% CI, 47-74%). High/iso SI on the HBP was highly accurate for distinguishing FNH from hepatocellular adenoma, with a summary sensitivity of 93.9% (95% CI, 89.1-97.1%) and a specificity of 95.3% (95% CI, 88.4-98.7%).
  
  
  CONCLUSIONS
  High/iso SI on the HBP of Gd-EOB-DTPA-MRI is characteristic and a prevalent finding of FNHs and can be helpful in the management of patients with FNH.
  
  
  CONCLUSIONS
  • The vast majority (94-97 %) of FNHs show high/iso SI on HBP. • High/iso SI on HBP was accurate for distinguishing FNH from hepatocellular adenoma. • HBP of Gd-EOB-DTPA-MRI can reduce unnecessary biopsies for the diagnosis of FNHs.
authors.affiliation: Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea.
authors.forename: Chong Hyun
authors.initials: CH
authors.lastname: Suh
authors.forename: Kyung Won
authors.initials: KW
authors.lastname: Kim
authors.forename: Gene Young
authors.initials: GY
authors.lastname: Kim
authors.forename: Yong Moon
authors.initials: YM
authors.lastname: Shin
authors.forename: Pyo Nyun
authors.initials: PN
authors.lastname: Kim
authors.forename: Seong Ho
authors.initials: SH
authors.lastname: Park
mesh_terms: D001706:Biopsy; D003287:Contrast Media; D020518:Focal Nodular Hyperplasia / Q000175:diagnosis* / Q000473:pathology; D019786:Gadolinium DTPA; D006801:Humans; D007089:Image Enhancement; D008099:Liver / Q000473:pathology; D008279:Magnetic Resonance Imaging / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
chemical_list: D003287:Contrast Media; C073590:gadolinium ethoxybenzyl DTPA; D019786:Gadolinium DTPA