Gadoxetic Acid Disodium (Gd-EOB-DTPA)-Enhanced Magnetic Resonance Imaging For The Detection Of Hepatocellular Malignant Tumor:a Meta-Analysis And The Relationship Between The Optimum Delay Time In Hepatobiliary Phase And Liver Function

Purpose: To evaluate the diagnostic value of gadoliniumethoxybenzyl diethylenetriamine pentaacetic acid (GdEOB-DTPA)-enhanced magnetic resonance imaging (MRI) for hepatocellular malignant tumor[Including liver metastases (LM) and hepatocellular carcinoma (HCC)].Materials and Methods:A systematic, comprehensiveliterature search was conducted in CBM [2011(Gd-EOB-DTPA was first approved in China in2011) to2013.5], VIP (2011to2013.5), CNKI (2011to2013.5)PubMed (2004[Gd-EOB-DTPA was first approved in Europe in2004] to April2013), Embase (2004to April2013), Web of Science(2004to April2013), and the Cochrane Library (2004to April2013). The Quality Assessment of Diagnostic Studies (QUADAS) items was used to evaluate the quality ofthe included studies. Stata12.0was used to analyze the data. Pooled sensitivity (SEN), pooled specificity (SPE),pooled positive likelihood ratio (PLR), pooled negative likelihood ratio (NLR), pooled diagnostic odds ratio (dOR),and summary receiver operating characteristic (SROC)curves were calculated to assess the diagnostic value ofthe individual diagnostic tests.Results:A total of19articles were included, involving2661nodules from six countries. The results of the Meta-analysis showed that the live metastases group pooled SEN, SPE, PLR, NLR and dOR were0.93[95%CI (0.88,0.96),0.91[95%CI (0.83,0.96),10.66[95%CI (5.49,20.67),0.075[95%CI (0.04,0.03),142.530[95%CI (62.080,327.237)], respectively. The area under curve of SROC was0.97, Q*=0.9171. And the results of the HCC group showed that the pooled SEN, SPE, PLR, NLR and dOR were0.92(95%CI:0.89-0.94)0.95(95%CI:0.93-0.97),18.87(95%CI:13.51-26.37),0.09(95%CI:0.07-0.12),and0.98(95%CI:0.95-0.99). and subgroup analyses were performed. Conclusion:Gd-EOB-DTPA-enhanced MRI has a definite value for the detection of hepatocellular malignant tumor. in particular, it has high sensitivity for the detection of LM lesions larger than10mm, and diagnosis using3.0T high-field MR system. it also has a high sensitivity for the detection of HCC lesions larger than10mm. Objective: To assess the optimum delay time in hepatobiliary phase in patients with or without normal liver function。Methods: In45consecutive patients with suspected focal liver lesions, dynamic MRI was performed after intravenous Gd-EOB-DTPA, followed by hepatobiliary phases at5,10and20min. The following items were assessed at each hepatobiliary phase:parenchymal enhancement, contrast agent excretion in bile ducts, lesion enhancement characteristics,Lesion-to-liver contrast-to-noise ratios(CNR) and signal-to-noise ratios(SNR). Results:There was no statistical difference between the groups of Child-pugh class A and groups of class B regarding delay time of10min or delay time of20min after Gd-EOB-DTPA injection;There was also no significant difference in terms of the parenchymal signal intensity increased for the groups of Child-pughclass A and groups of class B (P=0.767, P=0.594).In the groups of Child-pugh class A and groups of class B Biliary contrast agent excretion were first observed in61.3%,90.3%and38.5%,84.6%patients after10and20min respectively. Hepatobiliary lesion enhancement characteristics observed after5min persisted during later hepatobiliary phases.Conclusions:In the groups of Child-pugh class A and groups of class B if lesion characterisation is the primary reason for performing MRI, a hepatobiliary delay time of10min after Gd-EOB-DTPA injection is sufficient in patients.