Meta-Analysis
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 7, 2015; 21(5): 1621-1627
Published online Feb 7, 2015. doi: 10.3748/wjg.v21.i5.1621
Lesion discrimination with breath-hold hepatic diffusion-weighted imaging: A meta-analysis
Zhi-Guang Chen, Li Xu, Si-Wei Zhang, Yan Huang, Rui-Huan Pan
Zhi-Guang Chen, Li Xu, Si-Wei Zhang, Department of Radiology, Guangdong Provincial Traditional Chinese Medicine Hospital, Guangzhou 510120, Guangdong Province, China
Yan Huang, Rui-Huan Pan, Department of Neurology, Guangdong Provincial Traditional Chinese Medicine Hospital, Guangzhou 510120, Guangdong Province, China
Author contributions: Chen ZG and Xu L designed the study, analyzed the data and wrote the manuscript; Xu L and Pan RH contributed to the discussion; Xu L, Zhang SW and Huang Y revised the manuscript.
Supported by Grants from the Science Foundation of Guangdong Province for Doctorate Startup Project, No. S2012040006618; and the Postdoctoral Fund of Guangzhou University of Traditional Chinese Medicine, No. 20120621.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Li Xu, MD, Department of Radiology, Guangdong Provincial Traditional Chinese Medicine Hospital, No. 111 Da De Road, Guangzhou 510120, Guangdong Province, China. 985592610@qq.com
Telephone: +86-20-81887233 Fax: +86-20-81887233
Received: June 26, 2014
Peer-review started: June 27, 2014
First decision: July 21, 2014
Revised: August 23, 2014
Accepted: September 30, 2014
Article in press: September 30, 2014
Published online: February 7, 2015
Abstract

AIM: To investigate the diagnostic capability of breath-hold diffusion-weighted imaging (DWI) for differentiation between malignant and benign hepatic lesions.

METHODS: A total of 614 malignant liver lesions (132 hepatocellular carcinomas, 468 metastases and 14 intrahepatic cholangiocarcinomas) and 291 benign liver lesions (102 hemangiomas, 158 cysts, 24 focal nodular hyperplasia, 1 angiomyolipoma and 6 hepatic adenomas) were included from seven studies (eight sets of data).

RESULTS: The pooled sensitivity and specificity of breath-hold DWI were 0.93 [95% confidence interval (CI): 0.91-0.95] and 0.87 (95%CI: 0.83-0.91), respectively. The positive likelihood ratio and negative likelihood ratio were 7.28 (95%CI: 4.51-11.76) and 0.09 (95%CI: 0.05-0.17), respectively. The P value for χ2 heterogeneity for all pooled estimates was < 0.05. From the fitted summary receiver operating characteristic curve, the area under the curve and Q* index were 0.96 and 0.91, respectively. Publication bias was not present (t = 0.49, P = 0.64). The meta-regression analysis indicated that evaluated covariates including magnetic resonance imaging modality, echo time, mean age, maximum b factor, and number of b factors were not sources of heterogeneity (all P > 0.05).

CONCLUSION: Breath-hold DWI is useful for differentiating between malignant and benign hepatic lesions. The diffusion characteristics of benign lesions that mimic malignant ones have rarely been investigated.

Keywords: Breath-hold imaging, Diffusion-weighted imaging, Hepatic tumor, Meta-analysis

Core tip: We investigated the diagnostic capability of breath-hold diffusion-weighted imaging (DWI) and found that it is useful for differentiating between malignant and benign hepatic focal lesions. The diffusion characteristics of the benign liver lesions that mimic malignant lesions have rarely been investigated and further studies are needed. Standardization of the acquisition protocol for breath-hold DWI across multicenter trials is recommended.