Magnetic Resonance Imaging, Computed Tomography Provide Higher Sensitivity for Liver Cancer Diagnosis: AHRQ Review

The use of magnetic resonance imaging (MRI) and computed tomography (CT) to diagnose liver cancer is associated with higher sensitivity than ultrasonography without contrast, according to an AHRQ-funded literature review of different imaging techniques. Sensitivity refers to the ability of the test to correctly identify individuals with the disease. Worldwide, liver cancer is the fifth most common type of cancer and the third most common cause of death from cancer. The systematic review and meta-analysis, published in the journal Annals of Internal Medicine, included data from 1998 through 2014. It found that sensitivity was higher for MRI than for CT. For evaluation of focal liver lesions, sensitivities for the three imaging modalities were similar. The review, “Imaging Techniques for the Diagnosis of Hepatocellular Carcinoma: A Systematic Review and Meta-analysis,” and abstract were published May 19

2015 May 19;162(10):697-711. doi: 10.7326/M14-2509.

Imaging Techniques for the Diagnosis of Hepatocellular Carcinoma: A Systematic Review and Meta-analysis.

Chou R, Cuevas C, Fu R, Devine B, Wasson N, Ginsburg A, Zakher B, Pappas M, Graham E, Sullivan SD.

Erratum in

Ann Intern Med. 2015 Jun 16;162(12):880.

Abstract

BACKGROUND:

Several imaging modalities are available for diagnosis of hepatocellular carcinoma (HCC).

PURPOSE:

To evaluate the test performance of imaging modalities for HCC.

DATA SOURCES:

MEDLINE (1998 to December 2014), the Cochrane Library Database, Scopus, and reference lists.

STUDY SELECTION:

Studies on test performance of ultrasonography, computed tomography (CT), or magnetic resonance imaging (MRI).

DATA EXTRACTION:

One investigator abstracted data, and a second investigator confirmed them; 2 investigators independently assessed study quality and strength of evidence.

DATA SYNTHESIS:

Few studies have evaluated imaging for HCC in surveillance settings. In nonsurveillance settings, sensitivity for detection of HCC lesions was lower for ultrasonography without contrast than for CT or MRI (pooled difference based on direct comparisons, 0.11 to 0.22), and MRI was associated with higher sensitivity than CT (pooled difference, 0.09 [95% CI, 0.07 to 12]). For evaluation of focal liver lesions, there were no clear differences in sensitivity among ultrasonography with contrast, CT, and MRI. Specificity was generally 0.85 or higher across imaging modalities, but this item was not reported in many studies. Factors associated with lower sensitivity included use of an explanted liver reference standard, and smaller or more well-differentiated HCC lesions. For MRI, sensitivity was slightly higher for hepatic-specific than nonspecific contrast agents.

LIMITATIONS:

Only English-language articles were included, there was statistical heterogeneity in pooled analyses, and costs were not assessed. Most studies were conducted in Asia and had methodological limitations.

CONCLUSION:

CT and MRI are associated with higher sensitivity than ultrasonography without contrast for detection of HCC; sensitivity was higher for MRI than CT. For evaluation of focal liver lesions, the sensitivities of ultrasonography with contrast, CT, and MRI for HCC are similar.