title: Imaging Techniques for the Diagnosis of Hepatocellular Carcinoma: A Systematic Review and Meta-analysis.
abstract: BACKGROUND
  Several imaging modalities are available for diagnosis of hepatocellular carcinoma (HCC).
  
  
  OBJECTIVE
  To evaluate the test performance of imaging modalities for HCC.
  
  
  METHODS
  MEDLINE (1998 to December 2014), the Cochrane Library Database, Scopus, and reference lists.
  
  
  METHODS
  Studies on test performance of ultrasonography, computed tomography (CT), or magnetic resonance imaging (MRI).
  
  
  METHODS
  One investigator abstracted data, and a second investigator confirmed them; 2 investigators independently assessed study quality and strength of evidence.
  
  
  RESULTS
  Few studies have evaluated imaging for HCC in surveillance settings. In nonsurveillance settings, sensitivity for detection of HCC lesions was lower for ultrasonography without contrast than for CT or MRI (pooled difference based on direct comparisons, 0.11 to 0.22), and MRI was associated with higher sensitivity than CT (pooled difference, 0.09 [95% CI, 0.07 to 12]). For evaluation of focal liver lesions, there were no clear differences in sensitivity among ultrasonography with contrast, CT, and MRI. Specificity was generally 0.85 or higher across imaging modalities, but this item was not reported in many studies. Factors associated with lower sensitivity included use of an explanted liver reference standard, and smaller or more well-differentiated HCC lesions. For MRI, sensitivity was slightly higher for hepatic-specific than nonspecific contrast agents.
  
  
  CONCLUSIONS
  Only English-language articles were included, there was statistical heterogeneity in pooled analyses, and costs were not assessed. Most studies were conducted in Asia and had methodological limitations.
  
  
  CONCLUSIONS
  CT and MRI are associated with higher sensitivity than ultrasonography without contrast for detection of HCC; sensitivity was higher for MRI than CT. For evaluation of focal liver lesions, the sensitivities of ultrasonography with contrast, CT, and MRI for HCC are similar.
  
  
  BACKGROUND
  Agency for Healthcare Research and Quality. (
  CRD42014007016).
authors.forename: Roger
authors.initials: R
authors.lastname: Chou
authors.forename: Carlos
authors.initials: C
authors.lastname: Cuevas
authors.forename: Rongwei
authors.initials: R
authors.lastname: Fu
authors.forename: Beth
authors.initials: B
authors.lastname: Devine
authors.forename: Ngoc
authors.initials: N
authors.lastname: Wasson
authors.forename: Alexander
authors.initials: A
authors.lastname: Ginsburg
authors.forename: Bernadette
authors.initials: B
authors.lastname: Zakher
authors.forename: Miranda
authors.initials: M
authors.lastname: Pappas
authors.forename: Elaine
authors.initials: E
authors.lastname: Graham
authors.forename: Sean D
authors.initials: SD
authors.lastname: Sullivan
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000175:diagnosis*; D003287:Contrast Media; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis*; D008279:Magnetic Resonance Imaging; D012015:Reference Standards; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography
chemical_list: D003287:Contrast Media