title: Lesion discrimination with breath-hold hepatic diffusion-weighted imaging: a meta-analysis.
abstract: OBJECTIVE
  To investigate the diagnostic capability of breath-hold diffusion-weighted imaging (DWI) for differentiation between malignant and benign hepatic lesions.
  
  
  METHODS
  A total of 614 malignant liver lesions (132 hepatocellular carcinomas, 468 metastases and 14 intrahepatic cholangiocarcinomas) and 291 benign liver lesions (102 hemangiomas, 158 cysts, 24 focal nodular hyperplasia, 1 angiomyolipoma and 6 hepatic adenomas) were included from seven studies (eight sets of data).
  
  
  RESULTS
  The pooled sensitivity and specificity of breath-hold DWI were 0.93 [95% confidence interval (CI): 0.91-0.95] and 0.87 (95%CI: 0.83-0.91), respectively. The positive likelihood ratio and negative likelihood ratio were 7.28 (95%CI: 4.51-11.76) and 0.09 (95%CI: 0.05-0.17), respectively. The P value for χ (2) heterogeneity for all pooled estimates was < 0.05. From the fitted summary receiver operating characteristic curve, the area under the curve and Q* index were 0.96 and 0.91, respectively. Publication bias was not present (t = 0.49, P = 0.64). The meta-regression analysis indicated that evaluated covariates including magnetic resonance imaging modality, echo time, mean age, maximum b factor, and number of b factors were not sources of heterogeneity (all P > 0.05).
  
  
  CONCLUSIONS
  Breath-hold DWI is useful for differentiating between malignant and benign hepatic lesions. The diffusion characteristics of benign lesions that mimic malignant ones have rarely been investigated.
authors: Zhi-Guang Chen, Li Xu, Si-Wei Zhang, Department of Radiology, Guangdong Provincial Traditional Chinese Medicine Hospital, Guangzhou 510120, Guangdong Province, China.
authors: Zhi-Guang
authors: ZG
authors: Chen
authors: Zhi-Guang Chen, Li Xu, Si-Wei Zhang, Department of Radiology, Guangdong Provincial Traditional Chinese Medicine Hospital, Guangzhou 510120, Guangdong Province, China.
authors: Li
authors: L
authors: Xu
authors: Zhi-Guang Chen, Li Xu, Si-Wei Zhang, Department of Radiology, Guangdong Provincial Traditional Chinese Medicine Hospital, Guangzhou 510120, Guangdong Province, China.
authors: Si-Wei
authors: SW
authors: Zhang
authors: Zhi-Guang Chen, Li Xu, Si-Wei Zhang, Department of Radiology, Guangdong Provincial Traditional Chinese Medicine Hospital, Guangzhou 510120, Guangdong Province, China.
authors: Yan
authors: Y
authors: Huang
authors: Zhi-Guang Chen, Li Xu, Si-Wei Zhang, Department of Radiology, Guangdong Provincial Traditional Chinese Medicine Hospital, Guangzhou 510120, Guangdong Province, China.
authors: Rui-Huan
authors: RH
authors: Pan
mesh_terms: D000236:Adenoma / Q000473:pathology*; D019540:Area Under Curve; D001650:Bile Duct Neoplasms / Q000473:pathology*; D001653:Bile Ducts, Intrahepatic / Q000473:pathology*; D062485:Breath Holding; D006528:Carcinoma, Hepatocellular / Q000473:pathology*; D016009:Chi-Square Distribution; D018281:Cholangiocarcinoma / Q000473:pathology*; D003560:Cysts / Q000473:pathology*; D003937:Diagnosis, Differential; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D020518:Focal Nodular Hyperplasia / Q000473:pathology*; D006391:Hemangioma / Q000473:pathology*; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology* / Q000556:secondary; D016017:Odds Ratio; D011237:Predictive Value of Tests; D012372:ROC Curve
keywords: Breath-hold imaging; Diffusion-weighted imaging; Hepatic tumor; Meta-analysis