Performance of adding hepatobiliary phase image in magnetic resonance imaging for detection of hepatocellular carcinoma: a meta-analysis.

OBJECTIVES: To determine the performance of diagnostic algorithm of adding hepatobiliary phase (HBP) images in Gd-EOB-DTPA-enhanced MRI for the detection of hepatocellular carcinoma (HCC) measuring up to 3 cm in patients with chronic liver disease. METHODS: We searched multiple databases from inception to April 10, 2020, to identify studies on using Gd-EOB-DTPA-enhanced MRI for the diagnostic accuracy of HCC (≤ 3 cm) in patients with chronic liver disease. The diagnostic algorithm of Gd-EOB-DTPA-enhanced MRI with HBP for HCC was defined as a nodule showing hyperintensity during arterial phase and hypointensity during the portal venous, delayed, or hepatobiliary phases. For gadoxetic acid-enhanced MRI without HBP, the diagnostic criteria were a nodule showing arterial enhancement and hypointensity on the portal venous or delayed phases. The data were extracted to calculate summary estimates of sensitivity, specificity, diagnostic odds ratio, likelihood ratio, and summary receiver operating characteristic (sROC) by using a bivariate random-effects model. RESULTS: Twenty-nine studies with 2696 HCC lesions were included. Overall Gd-EOB-DTPA-enhanced MRI with HBP had a sensitivity of 87%, specificity of 92%, and the area under the sROC curve of 95%. The summary sensitivity of Gd-EOB-DTPA-enhanced MRI with HBP was significantly higher than that without HBP (84% vs 68%, p = 0.01). CONCLUSION: Gd-EOB-DTPA-enhanced MRI with HBP showed higher sensitivity than that without HBP and had comparable specificity for diagnosis of HCC in patients with chronic liver disease. KEY POINTS: • Hypointensity on HBP is a major feature for diagnosis of HCC. • Extending washout appearance to the transitional or hepatobiliary phase on Gd-EOB-DTPA provides favorable sensitivity and comparable specificity for diagnosis HCC. • The summary sensitivity of gadoxetic acid-enhanced MRI with HBP was significantly higher than that without HBP (84% vs 68%, p = 0.01) for diagnosis of HCC in patients with chronic liver disease.

[A preliminary study of dual-source computed tomography dual energy imaging in the diagnosis of acute traumatic bone marrow lesions in spine].

OBJECTIVE: To explore the feasibility of virtual noncalcium technique from dual-source computed tomography (DSCT) for the diagnosis of vertebral bone marrow lesions. METHODS: A total of 13 patients with acute vertebral bone marrow lesions underwent both DSCT and MRI within 3 days. And the DSCT dual-energy CT data were postprocessed for generating virtual noncalcium images and color-coded maps. Two radiologists analyzed the lesions of bone marrow by magnetic resonance (MR) imaging and virtual noncalcium images on a three-level. MR imaging interpretation served as the reference standard. Consistency check was conducted by using kappa statistics. And then the sensitivity of DSCT dual energy imaging was examined in the diagnosis of acute traumatic bone marrow lesions in spine. RESULTS: Among them, 13 vertebral body with bone marrow lesions were detected by MRI. The T2WI fat-suppression irregular high signal and slightly high density shadow under the background in noncalcium images corresponded to corresponding high signal areas on MRI. Interreader agreement was substantial for qualitative grading of DE CT images (κ = 0.629). The sensitivity of DSCT dual energy virtual noncalcium images in the diagnosis of acute traumatic bone marrow lesions in spine were 92.3% and 84.6% for observers 1 and 2. CONCLUSION: Distinct traumatic bone marrow lesions of spine may be diagnosed with a high sensitivity on virtual noncalcium images reconstructed from DSCT and color-coded maps. And it is worth further explorations.