title: Combined Application of Gadoxetic Acid Disodium-Enhanced Magnetic Resonance Imaging (MRI) and Diffusion-Weighted Imaging (DWI) in the Diagnosis of Chronic Liver Disease-Induced Hepatocellular Carcinoma: A Meta-Analysis.
abstract: OBJECTIVE
  Gadoxetic acid disodium (Gd-EOB-DTPA) is a magnetic resonance imaging (MRI) contrast agent to target the liver cells with normal function. In clinical practice, the Gd-EOB-DTPA produces high quality hepatocyte specific image 20 minutes after intravenous injection, so DWI sequence is often performed after the conventional dynamic scanning. However, there are still some disputes about whether DWI sequence will provide more effective diagnostic information in clinical practice. This study aimed to explore the diagnostic value of combining Gd-EOB-DTPA-enhanced MRI and DWI in the detection of hepatocellular carcinoma (HCC) in patients with chronic liver disease.
  
  
  METHODS
  A systematic literature search was performed in the PubMed and Cochrane library database up to March 2015. The quality assessment of diagnostic accuracy studies (QUADAS) was used to evaluate the quality of studies. Heterogeneous test on the included literature was performed by using the software Review Manager 5.3. The MetaDiSc 1.4 software was used to calculate the pooled sensitivity, specificity, positive likelihood ratio and negative likelihood ratio; meanwhile the summary receiver operating characteristics (SROC) curve was drawn to compare the diagnostic performance.
  
  
  RESULTS
  A total of 13 literatures were included in this study. In 8 literatures regarding HCC diagnosis based on Gd-EOB-DTPA-enhanced MRI, the pooled sensitivity: 0.90 (95% confidence interval (CI): 0.88-0.93); specificity: 0.89 (95% CI: 0.85-0.92); positive likelihood ratio: 8.60 (95% CI: 6.20-11.92); negative likelihood ratio: 0.10 (95% CI: 0.08-0.14) were obtained. The area under curve (AUC) and Q values were 0.96 and 0.90, respectively. In 5 literatures relating to HCC diagnosis by combination of Gd-EOB-DTPA-enhanced MRI and DWI sequence, the pooled sensitivity: 0.88 (95% CI: 0.85-0.91), specificity: 0.96 (0.94-0.97), positive likelihood ratio: 19.63 (12.77-30.16), negative likelihood ratio: 0.10 (0.07-0.14) were obtained. The AUC value was 0.9833 and Q value was 0.9436. The AUC value of comprehensive evaluation method was significantly higher than that of Gd-EOB-DTPA-enhanced MRI alone(P<0.05).
  
  
  CONCLUSIONS
  Combination of Gd-EOB-DTPA-enhanced MRI and DWI sequence significantly improves in both the diagnostic accuracy and specificity of chronic liver disease-associated HCC.
authors.affiliation: Department of Diagnostic Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China.
authors.forename: Xiang
authors.initials: X
authors.lastname: Li
authors.affiliation: Department of Diagnostic Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China.
authors.forename: Chenxia
authors.initials: C
authors.lastname: Li
authors.affiliation: Department of Diagnostic Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China.
authors.forename: Rong
authors.initials: R
authors.lastname: Wang
authors.affiliation: Department of Radiotherapy, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China.
authors.forename: Juan
authors.initials: J
authors.lastname: Ren
authors.affiliation: Department of Diagnostic Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China.
authors.forename: Jian
authors.initials: J
authors.lastname: Yang
authors.affiliation: Department of Diagnostic Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China.
authors.forename: Yuelang
authors.initials: Y
authors.lastname: Zhang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D006528:Carcinoma, Hepatocellular / Q000473:pathology*; D003287:Contrast Media / Q000378:metabolism; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods; D005260:Female; D019786:Gadolinium DTPA / Q000378:metabolism*; D006801:Humans; D008107:Liver Diseases / Q000473:pathology*; D008113:Liver Neoplasms / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D012680:Sensitivity and Specificity
chemical_list: D003287:Contrast Media; C073590:gadolinium ethoxybenzyl DTPA; D019786:Gadolinium DTPA