Quality Assessment of Ultrasound and Magnetic Resonance Imaging for Hepatocellular Carcinoma Surveillance: A Systematic Review and Meta-Analysis

Jingxuan Quek; Darren Jun Hao Tan; Kai En Chan; Wen Hui Lim; Cheng Han Ng; Yi Ping Ren; Teng Kiat Koh; Readon Teh; Jieling Xiao; Clarissa Fu; Nicholas Syn; Margaret Teng; Mark Muthiah; Kathryn J Fowler; Claude B Sirlin; Rohit Loomba; Daniel Q Huang

doi:10.1159/000531016

Quality Assessment of Ultrasound and Magnetic Resonance Imaging for Hepatocellular Carcinoma Surveillance: A Systematic Review and Meta-Analysis

Dig Dis. 2023;41(5):757-766. doi: 10.1159/000531016. Epub 2023 May 11.

Authors

Jingxuan Quek¹, Darren Jun Hao Tan¹, Kai En Chan¹, Wen Hui Lim¹, Cheng Han Ng¹, Yi Ping Ren¹, Teng Kiat Koh¹, Readon Teh², Jieling Xiao¹, Clarissa Fu¹, Nicholas Syn¹, Margaret Teng², Mark Muthiah^{1

2}, Kathryn J Fowler³, Claude B Sirlin³, Rohit Loomba⁴, Daniel Q Huang^{1

2

4}

Affiliations

¹ Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
² Division of Gastroenterology and Hepatology, Department of Medicine, National University Health System, Singapore, Singapore.
³ Liver Imaging Group, Department of Radiology, University of California San Diego, La Jolla, California, USA.
⁴ Division of Gastroenterology, NAFLD Research Center, University of California at San Diego, La Jolla, California, USA.

PMID: 37231918
DOI: 10.1159/000531016

Abstract

Introduction: To achieve early detection and curative treatment options, surveillance imaging for hepatocellular carcinoma (HCC) must remain of quality and without substantial limitations in liver visualization. However, the prevalence of limited liver visualization during HCC surveillance imaging has not been systematically assessed. Utilizing a systematic review and meta-analytic approach, we aimed to determine the prevalence of limited liver visualization during HCC surveillance imaging.

Methods: MEDLINE and Embase electronic databases were searched to identify published data on liver visualization limitations of HCC surveillance imaging. An analysis of proportions was pooled using a generalized linear mixed model with Clopper-Pearson intervals. Risk factors were analysed using a generalized mixed model with a logit link and inverse variance weightage.

Results: Of 683 records, 10 studies (7,131 patients) met inclusion criteria. Seven studies provided data on liver visualization limitations on ultrasound (US) surveillance exams: prevalence of limited liver visualization was 48.9% (95% CI: 23.5-74.9%) in the overall analysis and 59.2% (95% CI: 24.2-86.9%) in a sensitivity analysis for cirrhotic patients. Meta-regression determined that non-alcoholic fatty liver disease was associated with limited liver visualization on US. Four studies provided data for liver visualization limitations in abbreviated magnetic resonance imaging (aMRI), with inadequate visualization ranging from 5.8% to 19.0%. One study provided data for complete MRI and none for computed tomography.

Conclusion: A substantial proportion of US exams performed for HCC surveillance provide limited liver visualization, especially in cirrhosis, which may hinder detection of small observations. Alternative surveillance strategies including aMRI may be appropriate for patients with limited US visualization.

Keywords: Hepatocellular carcinoma; Liver cancer; Magnetic resonance imaging; Screening; Ultrasound.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Carcinoma, Hepatocellular* / diagnosis
Contrast Media
Humans
Liver Cirrhosis / complications
Liver Neoplasms* / diagnosis
Magnetic Resonance Imaging / methods
Retrospective Studies
Risk Factors
Sensitivity and Specificity

Substances

Contrast Media