Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.
Liver Imaging Group, Department of Radiology, University of California San Diego, San Diego, CA, USA.
Evidence-based Practice Center, Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.
Multiphasic computed tomography (CT) and magnetic resonance imaging (MRI) are both used for non-invasive diagnosis of hepatocellular carcinoma (HCC) in patients with cirrhosis. To determine if there is a relative diagnostic benefit of one over the other, we synthesized evidence regarding the relative performances of CT, extracellular-contrast-enhanced-MRI, and gadoxetate-enhanced-MRI for diagnosis of HCC in patients with cirrhosis. We also assessed whether liver biopsy versus follow-up with the same versus alternative imaging is best for CT- or MRI-indeterminate liver nodules in patients with cirrhosis. We searched multiple databases from inception to April 27, 2016 for studies comparing CT with extracellular-contrast-enhanced-MRI or gadoxetate-enhanced-MRI in adults with cirrhosis and suspected HCC. Two reviewers independently selected studies and extracted data. Of 33 included studies, 19 were comprehensive, while 14 reported sensitivity only. For all tumor sizes, the 19 comprehensive comparisons showed significantly higher sensitivity (0.82 vs. 0.66) and lower negative likelihood ratio (0.20 vs. 0.37) for MRI over CT. The specificities of MRI vs. CT (0.91 vs. 0.92) and the positive likelihood ratios (8.8 vs. 8.1) were not different. All three modalities performed better for HCCs ≥2 cm. Performance was poor for HCCs <1 cm. No studies examined whether adults with cirrhosis and an indeterminate nodule are best evaluated using biopsy, repeated imaging or alternative imaging. Concerns about publication bias, inconsistent study results, low study quality, and clinical factors precluded support for exclusive use of either gadoxetate-enhanced or extracellular-contrast-enhanced MRI over CT.
CT, extracellular-contrast-enhanced-MRI or gadoxetate-enhanced-MRI could not be definitively preferred for HCC diagnosis in patients with cirrhosis. In patients with cirrhosis and an indeterminate mass, there was insufficient data comparing biopsy to repeat cross-sectional imaging or,alternative imaging.