title: Comparative 13-year meta-analysis of the sensitivity and positive predictive value of ultrasound, CT, and MRI for detecting hepatocellular carcinoma.
abstract: OBJECTIVE
  To compare the per-lesion sensitivity and positive predictive value (PPV) of ultrasonography (US), computed tomography (CT), and magnetic resonance imaging (MRI) for the diagnosis of hepatocellular carcinoma (HCC).
  
  
  METHODS
  The meta-analysis of sensitivity included 242 studies (15,713 patients); 116 studies (7492 patients) allowed calculation of PPV. Pooled per-lesion sensitivity and PPV for HCC detection were compared using empirical Bayes estimates of a beta-binomial model.
  
  
  RESULTS
  The pooled per-lesion sensitivity and PPV of contrast-enhanced CT (73.6%, 85.8%) and gadolinium-enhanced MRI (77.5%, 83.6%) are not significantly different (P = 0.08, P = 0.2). However, if the hepatobiliary agent gadoxetate is used, MRI has significantly higher pooled per-lesion sensitivity and PPV (85.6%, 94.2%) than CT (P < 0.0001) or than MRI with other agents (P < 0.0001). Non-contrast-enhanced US has the lowest overall sensitivity and PPV (59.3%, 77.4%). Pooled per-lesion sensitivity and PPV of contrast-enhanced US (84.4%, 89.3%) are relatively high, but no contrast-enhanced US study used the most rigorous reference standards.
  
  
  CONCLUSIONS
  MRI utilizing the hepatobiliary agent gadoxetate has the highest overall sensitivity and PPV, and may be the single optimal method for diagnosis of HCC. Non-contrast-enhanced US has the lowest sensitivity and PPV. More rigorous reference standards are needed to compare the performance of contrast-enhanced US with CT and MRI. Differences in sensitivity and PPV between CT and conventional gadolinium-enhanced MRI are not statistically significant overall.
authors.affiliation: Department of Diagnostic Radiology, Columbia University, New York Presbyterian Hospital, 622 West 168th Street, New York, NY, 10032, USA.
authors.forename: Robert F
authors.initials: RF
authors.lastname: Hanna
authors.affiliation: Department of Diagnostic Radiology, Columbia University, New York Presbyterian Hospital, 622 West 168th Street, New York, NY, 10032, USA.
authors.forename: Vesselin Z
authors.initials: VZ
authors.lastname: Miloushev
authors.affiliation: Department of Radiology, Hôpital Saint-Luc, University of Montreal, 1058 Rue Saint-Denis, Montreal, QC, H2X 3J4, Canada. an.tang@umontreal.ca.
authors.forename: An
authors.identifier: http://orcid.org/0000-0001-8967-5503
authors.initials: A
authors.lastname: Tang
authors.affiliation: Department of Diagnostic Radiology, Columbia University, New York Presbyterian Hospital, 622 West 168th Street, New York, NY, 10032, USA.
authors.forename: Lee A
authors.initials: LA
authors.lastname: Finklestone
authors.affiliation: Department of Diagnostic Radiology, Columbia University, New York Presbyterian Hospital, 622 West 168th Street, New York, NY, 10032, USA.
authors.forename: Sidney Z
authors.initials: SZ
authors.lastname: Brejt
authors.affiliation: Department of Diagnostic Radiology, Columbia University, New York Presbyterian Hospital, 622 West 168th Street, New York, NY, 10032, USA.
authors.forename: Ranjit S
authors.initials: RS
authors.lastname: Sandhu
authors.affiliation: Liver Imaging Group, Department of Radiology, University of California San Diego, 200 W Arbor Drive, San Diego, CA, 92103, USA.
authors.forename: Cynthia S
authors.initials: CS
authors.lastname: Santillan
authors.affiliation: Computational and Applied Statistics Laboratory (CASL), SDSC, University of California at San Diego, MC 0505, 9500 Gilman Dr., La Jolla, CA, 92093-0505, USA.
authors.forename: Tanya
authors.initials: T
authors.lastname: Wolfson
authors.affiliation: Computational and Applied Statistics Laboratory (CASL), SDSC, University of California at San Diego, MC 0505, 9500 Gilman Dr., La Jolla, CA, 92093-0505, USA.
authors.forename: Anthony
authors.initials: A
authors.lastname: Gamst
authors.affiliation: Liver Imaging Group, Department of Radiology, University of California San Diego, 200 W Arbor Drive, San Diego, CA, 92103, USA.
authors.forename: Claude B
authors.initials: CB
authors.lastname: Sirlin
mesh_terms: D001499:Bayes Theorem; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis* / Q000000981:diagnostic imaging; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging; D008279:Magnetic Resonance Imaging / Q000379:methods*; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014463:Ultrasonography / Q000379:methods*
keywords: Computed tomography; Diagnostic performance; Hepatocellular carcinoma; Magnetic resonance imaging; Meta-analysis; Ultrasound