Meta-analysis Of Diagnostic Value Of Contrast-enhanced Ultrasound?Contrast-enhanced Computed Tomography And Gd-EOB-DTPA Contrast-enhanced Magnetic Resonance Imaging In Detecting Small Hepatocellular Carcinoma

Objective This study used a meta-analysis to systematically evaluate relevant clinical data at home and abroad.The aim of this study was to compare contrast-enhanced ultrasound(CEUS),contrast-enhanced computed tomography(CECT),and Gd-EOB-DTPA-contrast-enhanced magnetic resonance imaging(CEMRI)in the detection of small hepatocellular carcinoma(SHCC).Methods A series of related articles from 2001 to 2018 were searched in PubMed and Embase databases.Quality assessment of diagnostic studies 2(QUADAS-2)was used to evaluate the quality of each study included.Data from selected articles were pooled to analyze the sensitivity,specificity,positive likelihood ratio(PLR),negative likelihood ratio(NLR),diagnostic odds ratio(DOR),and summary receiver operating characteristic(SROC)curve using Meta-DiSc software.the area under the integrated receiver operating characteristic curve(AUC-SROC)were calculated to compare the diagnostic efficacy of contrast-enhanced ultrasound,contrast-enhanced CT,and Gd-EOB-DTPA-contrast-enhanced MRI.Heterogeneity was estimated using x2-based Cochran-Q test and 12-statistics,and publication bias was estimated using Deek's test in Stata software.Results According to the inclusion criteria,38 eligible studies were selected(published from 2001 to 2018),In the extracted data,no Threshold effects were observed in contrast-enhanced ultrasound,CECT,and Gd-EOB-DTPA-enhanced MRI,but there were different degrees of heterogeneity among the samples.Enhancement of CT,Gd-EOB-DTPA-enhanced MRI Deeks' funnel plots suggest that there is no significant publication bias in the included studies,and the corresponding inclusion studies are essentially symmetrically distributed.Contrast-enhanced Deeks' funnel plot showed publication bias in the included studies(p<0.05).The following respective data on CEUS?CECT?Gd-EOB-DTPA-CEMRI were pooled:sensitivities:0.82(95%CI,0.79-0.85)?0.69(95%CI,0.66-0.72)and 0.91(95%Cl,0.89-0.92);specificity:0.87(95%Cl,0.84-0.90).0.91(95%CI,0.89-0.93)and 0.91(95%CI,0.89-0.93);PLRs:5.35(95%CI,2.25-12.71)?6.82(95%CI,4.67-9.97)and 9.88(95%CI,5.56-17.56);NLRs:0.27(95%CI,0.16-0.44)?0.37(95%CI,0.31-0.45)and 0.10(95%CI,0.07-0.15);DORs:22.96(95%CI,8.96-58.86)?22.65(95%CI,13.90-36.94)and 125.53(95%CI,57.64-273.41).Area under the SROC curve:0.8888?0.8675 and 0.9689.Conclusion 1.Contrast-enhanced ultrasound,enhanced CT and Gd-EOB-DTPA enhancement MRI has high diagnostic accuracy for SHCC.2.Gd-EOB-DTPA-enhanced MRI showed better sensitivity and overall accuracy without loss of specificity compared with enhanced CT and contrast-enhanced ultrasound.3.The sensitivity of contrast-enhanced ultrasound is significantly better than that of enhanced CT.The diagnostic specificity is obviously lower than that of enhanced CT.The diagnostic accuracy of the two is quite similar.