title: Could ADC values be a promising diagnostic criterion for differentiating malignant and benign hepatic lesions in Asian populations: A meta-analysis.
abstract: BACKGROUND
  Liver cancer exhibits geographic and ethnic differences in its prevalence and biology, which implies that it is impractical to develop universal guidelines for all patients. Thus, a meta-analysis was conducted to identify the accuracy of apparent diffusion coefficients (ADCs) for discriminating malignant from benign liver lesions in Asians.
  
  
  METHODS
  Eligible studies published in PubMed, Ovid, and Embase/Medline were updated onto October 2014. STATA 12.0 and Meta-Disc 1.4 were used to perform this meta-analysis.
  
  
  RESULTS
  Eight studies comprising 661 benign liver lesions and 598 malignant liver lesions fulfilled all the inclusion criteria. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were 0.88 (95% confidence interval [CI] 0.75-0.95), 0.93 (95% CI 0.86-0.97), 12.42 (95% CI 6.09-25.31), 0.13 (95% CI 0.06-0.29), and 95.58 (95% CI 35.29-258.89), respectively. Overall, the area under the summary receiver-operating characteristic curve was 0.96 (95% CI 0.94-0.98). Heterogeneity was found to originate potentially from the type of benign lesion. A subgroup analysis showed that differentiating between hemangiomas, cysts, and malignant liver lesions produced a significantly higher diagnostic accuracy than that of solid liver lesions.
  
  
  CONCLUSIONS
  Our meta-analysis indicated that ADC could be promising for characterizing liver lesions among Asians, indicating that the ADC value is a promising diagnostic criterion candidate. Meanwhile, the use of dual b values could be sufficient for liver lesion characterization. However, large-scale, high-quality trials should be conducted to identify specific standards, including cut-off values for further development of diffusion-weighted imaging as a routine clinical application among Asian populations.
authors.affiliation: Department of Radiology, the Second Hospital of Tianjin Medical University, Tianjin, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Peng
authors.forename: Jing-Jin
authors.initials: JJ
authors.lastname: Li
authors.forename: Jiang
authors.initials: J
authors.lastname: Li
authors.forename: He-Wen
authors.initials: HW
authors.lastname: Li
authors.forename: Guo-Ping
authors.initials: GP
authors.lastname: Xu
authors.forename: Rong-Rong
authors.initials: RR
authors.lastname: Jia
authors.forename: Xue-Ning
authors.initials: XN
authors.lastname: Zhang
authors.forename: Yang
authors.initials: Y
authors.lastname: Zhao
mesh_terms: D044466:Asian People; D003937:Diagnosis, Differential; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000208:ethnology* / Q000473:pathology*; D012680:Sensitivity and Specificity