Meta-Analysis
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Jun 15, 2024; 16(6): 2804-2815
Published online Jun 15, 2024. doi: 10.4251/wjgo.v16.i6.2804
Dynamic contrast enhanced ultrasound in differential diagnosis of hepatocellular carcinoma: A systematic review and meta-analysis
Giorgio Esposto, Paolo Santini, Fabrizio Termite, Linda Galasso, Irene Mignini, Maria Elena Ainora, Antonio Gasbarrini, Maria Assunta Zocco
Giorgio Esposto, Fabrizio Termite, Linda Galasso, Irene Mignini, Maria Elena Ainora, Maria Assunta Zocco, Department of CEMAD Digestive Disease Center, Fondazione Policlinico Universitario A Gemelli IRCCS, Catholic University of Rome, Rome 00168, Italy
Paolo Santini, Department of Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome 00168, Italy
Antonio Gasbarrini, Department of Medicina Interna e Gastroenterologia, CEMAD Digestive Disease Center, Fondazione Policlinico Universitario A Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome 00168, Italy
Author contributions: Esposto G, Santini P, Termite F, Galasso L, and Mignini I were responsible for writing original draft preparation; Santini P was responsible for data analysis; Ainora ME and Zocco MA were responsible for writing review and editing; Gasbarrini A was responsible for supervision; Zocco MA proposed conceptualization; all authors have read and agreed to the published version of the manuscript.
Conflict-of-interest statement: All authors declare no conflicts-of-interest related to this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Maria Assunta Zocco, MD, PhD, Professor, Department of CEMAD Digestive Disease Center, Fondazione Policlinico Universitario A Gemelli IRCCS, Catholic University of Rome, Largo Gemelli 1, Rome 00168, Italy. mariaassunta.zocco@unicatt.it
Received: January 20, 2024
Revised: April 14, 2024
Accepted: April 28, 2024
Published online: June 15, 2024
Processing time: 146 Days and 5 Hours
Abstract
BACKGROUND

Non-invasive differential diagnosis between hepatocellular carcinoma (HCC) and other liver cancer (i.e. cholangiocarcinoma or metastasis) is highly challenging and definitive diagnosis still relies on histological exam. The patterns of enhancement and wash-out of liver nodules can be used to stratify the risk of malignancy only in cirrhotic patients and HCC frequently shows atypical features. Dynamic contrast-enhanced ultrasound (DCEUS) with standardized software could help to overcome these obstacles, providing functional and quantitative parameters and potentially improving accuracy in the evaluation of tumor perfusion.

AIM

To explore clinical evidence regarding the application of DCEUS in the differential diagnosis of liver nodules.

METHODS

A comprehensive literature search of clinical studies was performed to identify the parameters of DCEUS that could relate to histological diagnosis. In accordance with the study protocol, a qualitative and quantitative analysis of the evidence was planned.

RESULTS

Rise time was significantly higher in HCC patients with a standardized mean difference (SMD) of 0.83 (95%CI: 0.48-1.18). Similarly, other statistically significant parameters were mean transit time local with a SMD of 0.73 (95%CI: 0.20-1.27), peak enhancement with a SMD of 0.37 (95%CI: 0.03-0.70), area wash-in area under the curve with a SMD of 0.47 (95%CI: 0.13-0.81), wash-out area under the curve with a SMD of 0.55 (95%CI: 0.21-0.89) and wash-in and wash-out area under the curve with SMD of 0.51 (95%CI: 0.17-0.85). SMD resulted not significant in fall time and wash-in rate, but the latter presented a trend towards greater values in HCC compared to intrahepatic cholangiocarcinoma.

CONCLUSION

DCEUS could improve non-invasive diagnosis of HCC, leading to less liver biopsy and early treatment. This quantitative analysis needs to be applied on larger cohorts to confirm these preliminary results.

Keywords: Dynamic contrast enhanced ultrasound; Hepatocellular carcinoma; Intracellular cholangiocarcinoma; Quantitative ultrasound; Liver cancer; Time-intensity curve

Core Tip: Dynamic contrast enhanced ultrasound (DCEUS) is a novel technique that could help to overcome the diagnostic limits of standard contrast enhanced ultrasound. The parameters derived from the quantitative analysis of the time-intensity curve could give pivotal information upon the histotype of liver nodules. The aim of this paper is to explore clinical evidence regarding DCEUS application for differential diagnosis of liver nodules. To the best of our knowledge, this is the first systematic review and meta-analysis on this topic.