Hepatic adenoma subtypes on hepatobiliary phase of gadoxetic acid–enhanced MRI: Systematic review and meta-analysis Review
| Authors: | Kim, T. H.; Woo, S.; Ebrahimzadeh, S.; McInnes, M. D. F.; Gerst, S. R.; Do, R. K. |
| Review Title: | Hepatic adenoma subtypes on hepatobiliary phase of gadoxetic acid–enhanced MRI: Systematic review and meta-analysis |
| Abstract: | BACKGROUND. Accumulating evidence indicates that hepatocellular adenoma (HCA) may have a higher frequency of hepatobiliary phase (HBP) iso- or hyperintensity than previously reported. OBJECTIVE. The purpose of this study was to evaluate the proportion of HCA that shows iso- or hyperintensity in the HBP of gadoxetic acid–enhanced MRI, stratified by HCA subtype (HNF1a-inactivated [H-HCA], inflammatory [I-HCA], β-catenin–activated [B-HCA], and unclassified [U-HCA] HCA), and to assess the diagnostic performance of HBP iso- or hyperintensity for differentiating focal nodular hyperplasia (FNH) from HCA. EVIDENCE ACQUISITION. PubMed, Embase, and Cochrane Central Register of Controlled Trials were searched through February 14, 2022, for articles reporting HBP signal intensity on gadoxetic acid–enhanced MRI among pathologically proven HCAs, stratified by subtype. The pooled proportion of HBP iso- or hyperintensity was determined for each subtype and compared using metaregression. Diagnostic performance of HBP iso- or hyperintensity for differentiating FNH from all HCA subtypes combined and from B-HCA and U-HCA combined was assessed using bivariate modeling. EVIDENCE SYNTHESIS. Twenty-eight studies (12 original investigations, 16 case reports or case series) were included, yielding 364 patients with 410 HCAs (112 H-HCAs, 203 I-HCAs, 33 B-HCAs, 62 U-HCAs). Pooled proportion of HBP iso- or hyperintensity was 14% (95% CI, 4–26%) among all HCAs, 0% (95% CI, 0–2%) among H-HCAs, 11% (95% CI, 0–29%) among U-HCAs, 14% (95% CI, 2–31%) among I-HCAs, and 59% (95% CI, 26–88%) among B-HCAs; metaregression showed significant difference among subtypes (p < .001). In four studies reporting diagnostic performance information, HBP iso- or hyperintensity had sensitivity of 99% (95% CI, 57–100%) and specificity of 89% (95% CI, 82–94%) for differentiating FNH from all HCA subtypes and sensitivity of 99% (95% CI, 53–100%) and specificity of 65% (95% CI, 44–80%) for differentiating FNH from B-HCA or U-HCA. CONCLUSION. HCA subtypes other than H-HCA show proportions of HBP iso- or hyperintensity ranging from 11% (U-HCA) to 59% (B-HCA). Low prevalence of B-HCA has contributed to prior reports of high diagnostic performance of HBP iso- or hyperintensity for differentiating FNH from HCA. CLINICAL IMPACT. Radiologists should recognize the low specificity of HBP iso- or hyperintensity on gadoxetic acid–enhanced MRI for differentiating FNH from certain HCA subtypes. © American Roentgen Ray Society. |
| Keywords: | retrospective studies; liver neoplasms; nuclear magnetic resonance imaging; magnetic resonance imaging; sensitivity and specificity; disease association; diagnosis, differential; differential diagnosis; prevalence; diagnostic imaging; retrospective study; amine; amines; diagnostic value; systematic review; contrast enhancement; liver tumor; contrast medium; contrast media; gadolinium pentetate; gadolinium dtpa; liver adenoma; adenoma, liver cell; beta catenin; meta analysis; mri; case study; nodular hyperplasia; focal nodular hyperplasia; gadoxetic acid; humans; human; article; hepatobiliary parameters; hepatocyte nuclear factor 1alpha; gadolinium ethoxybenzyl dtpa; liver cell adenoma |
| Journal Title: | American Journal of Roentgenology |
| Volume: | 220 |
| Issue: | 1 |
| ISSN: | 0361-803X |
| Publisher: | American Roentgen Ray Society |
| Date Published: | 2023-01-01 |
| Start Page: | 28 |
| End Page: | 39 |
| Language: | English |
| DOI: | 10.2214/ajr.22.27989 |
| PUBMED: | 35920706 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | The MSK Cancer Center Support Grant (P30 CA008748) is acknowledged in the PDF -- Corresponding author is MSK author: Tae-Hyung Kim -- Source: Scopus |
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