Roger Chou, MD; Carlos Cuevas, MD; Rongwei Fu, PhD; Beth Devine, PhD, PharmD, MBA; Ngoc Wasson, MPH; Alexander Ginsburg, MA; Bernadette Zakher, MBBS; Miranda Pappas, MA; Elaine Graham, MLS; Sean D. Sullivan, PhD
Disclaimer: The findings and conclusions in this document are those of the authors, who are responsible for its content, and do not necessarily represent the views of the Agency for Healthcare Research and Quality (AHRQ). No statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.
Grant Support: By the Agency for Healthcare Research and Quality (contract 290-2007-10057-I, task order 8).
Acknowledgment: The authors thank Tracy Dana, MLS, for assistance with literature search strategy development; Monica Daeges, BA, and Sara Grusing, BS, for manuscript and library assistance; Leah Williams, BS, for editorial support; and AHRQ Task Order Officer Nahed El-Kassar, MD, PhD.
Disclosures: Dr. Chou reports grants from AHRQ during the conduct of the study. Dr. Cuevas reports grants from AHRQ during the conduct of the study and has received grants from National Institutes of Health (NIH R21: Minimally Invasive Ablative Therapies for Pancreatic Mucinous Cystic Neoplasms) outside the submitted work. Dr. Fu reports funds from Oregon Health & Science University during the conduct of the study. Ms. Graham reports funds from AHRQ during the conduct of the study. Dr. Zakher reports funds from AHRQ during the conduct of the study. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M14-2509.
Requests for Single Reprints: Roger Chou, MD, Oregon Health & Science University, Mail Code BICC, 3181 Southwest Sam Jackson Park Road, Portland, OR 97239-3098; e-mail, email@example.com.
Current Author Addresses: Dr. Chou: The Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, Mail Code BICC, 3181 Southwest Sam Jackson Park Road, Portland, OR 97239-3098.
Dr. Cuevas: Department of Radiology, University of Washington, Box 357115, 1959 NE Pacific Street, Seattle, WA 98195-7115.
Drs. Fu and Zakher, Ms. Wasson, Ms. Pappas, and Ms. Graham: The Pacific Northwest Evidence-based Practice Center, Department of Medicine, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Mail Code BICC, 3181 Southwest Sam Jackson Park Road, Portland, OR 97239-3098.
Dr. Devine: University of Washington, Department of Pharmacy, Box 357630, 1959 NE Pacific Street, Seattle, WA 98195-7630.
Mr. Ginsburg: Mayo Medical School, 200 First Street SW, Rochester, MN 55905.
Dr. Sullivan: School of Pharmacy, University of Washington, Box 357631, 1959 NE Pacific Street, Seattle, WA 98195-7631.
Author Contributions: Conception and design: R. Chou, C. Cuevas, E. Graham, S.D. Sullivan.
Analysis and interpretation of the data: R. Chou, C. Cuevas, R. Fu, B. Devine, N. Wasson, A. Ginsburg, B. Zakher, S.D. Sullivan.
Drafting of the article: R. Chou, N. Wasson.
Critical revision of the article for important intellectual content: R. Chou, C. Cuevas, R. Fu, B. Devine, N. Wasson, A. Ginsburg, B. Zakher, S.D. Sullivan.
Final approval of the article: R. Chou, C. Cuevas, R. Fu, B. Devine, N. Wasson, M. Pappas, E. Graham, S.D. Sullivan.
Provision of study materials or patients: C. Cuevas, N. Wasson.
Statistical expertise: R. Chou, R. Fu.
Obtaining of funding: R. Chou, E. Graham, S.D. Sullivan.
Administrative, technical, or logistic support: R. Chou, N. Wasson, A. Ginsburg, M. Pappas, E. Graham.
Collection and assembly of data: R. Chou, C. Cuevas, B. Devine, N. Wasson, A. Ginsburg, B. Zakher, M. Pappas, E. Graham, S.D. Sullivan.
This article has been corrected. The original version (PDF) is appended to this article as a Supplement.
Several imaging modalities are available for diagnosis of hepatocellular carcinoma (HCC).
To evaluate the test performance of imaging modalities for HCC.
MEDLINE (1998 to December 2014), the Cochrane Library Database, Scopus, and reference lists.
Studies on test performance of ultrasonography, computed tomography (CT), or magnetic resonance imaging (MRI).
One investigator abstracted data, and a second investigator confirmed them; 2 investigators independently assessed study quality and strength of evidence.
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.
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.
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.
Agency for Healthcare Research and Quality. (PROSPERO: CRD42014007016)
Chou R, Cuevas C, Fu R, et al. Imaging Techniques for the Diagnosis of Hepatocellular Carcinoma: A Systematic Review and Meta-analysis. Ann Intern Med. 2015;162:697–711. doi: https://doi.org/10.7326/M14-2509
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Published: Ann Intern Med. 2015;162(10):697-711.
Gastroenterology/Hepatology, Gastrointestinal Cancer, Hematology/Oncology, Liver Cancer, Liver Disease.
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