Comparative Study Of Gd-EOB-DTPA-MRI,CECT And CEUS In The Diagnosis Of Hepatocellular Carcinoma

Part one Retrospective Study of Gd-EOB-DTPA-MRI 、CECT and CEUS in the Diagnosis of HCCObjective: 1.The ability of GD-EOB-DTPA-MRI and CECT to detect HCC lesions was compared.2.We aimed to evaluate the diagnostic performance of GD-EOB-DTPA-MRI and CEUS for HCC,especially for small(diameter < 2cm)of intrahepatic lesions.3.This research aims to ascertain the sensitivity,specificity,and diagnostic accuracy of CECT and CEUS for HCC.Methods: 1.Clinical data pertaining to patients meeting the inclusion criteria were extracted from the imaging system and medical records.All patients underwent GD-EOB-DTPA-MRI and CECT examinations at the same time.Patients were divided into two groups: a MRI group and a CECT group,and self-comparison analysis was conducted.Postoperative histopathological examination was the gold standard for diagnosis of patients.2.Clinical data pertaining to patients undergoing hepatectomy due to hepatic lesions were retrospectively analyzed.They underwent GD-EOB-DTPA-MRI and CEUS detection before surgery.Liver lesions were pathologically examined in all patients.In preoperative imaging diagnosis and postoperative pathological diagnosis: The primary diagnosis of the patient was determined by the main lesion of the liver.In patients with a single lesion of the liver,a single lesion was defined as the main lesion.In patients with multiple lesions in the liver,if all lesions were benign,the largest lesion was identified as the main lesion,and if one lesion was malignant,this lesion was identified as the main lesion.When more than one lesion was malignant,the largest lesion was identified as the main lesion.3.The clinical data pertaining to patients who underwent hepatectomy and CECT and CEUS before surgery were retrospectively analyzed.The results of CECT and CEUS were compared with the pathological results.The gold standard was deemed to be those postoperative pathological examination results.Results: 1.A total of 145 patients were included.These patients included119 males and 26 females,with a median age of 55.3 years(between 17 and 88years).The diameter of the lesion was 0.5 to 20.5 cm.A total of 196 lesions were detected.Both imaging methods could accurately detect lesions with diameters greater than 2 cm.For lesions smaller than 2 cm,MRI detected 56 lesions,whilst CECT detected 24 lesions indicating that MRI found more than twice as many lesions as CECT.In addition,MRI detected additional lesions in23 cases(15.9% in a total of 145 cases)that were not diagnosed by CECT.Amongst these cases,one patient was diagnosed as having no lesion by CECT.2.A total of 216 patients were included,including male/female: 174/42,with an average age of 52 years(51 ± 12 years)and an average diameter of 5.3 cm(0.7to 19.5 cm).A total of 309 lesions including 257 malignant lesions(239 HCC)were found.Regarding lesions with a diameter of less than 2 cm,135 such lesions were detected by MRI,whereas only 85 were detected by CEUS.In the detection of benign and non-HCC lesions,the specificity of MRI combined with CEUS was higher than that of MRI and CEUS alone(p < 0.05).3.A total of 554 patients were included,including 440 males and 114 females,with an average age of 51 years(17 to 88 years)and an average lesion diameter of 5.8 cm(0.8 to20.1 cm).A total of 650 lesions including 548 malignant lesions(517 HCC)were detected.For HCC lesions,CECT and CEUS showed similar diagnostic performance,and there was no significant difference in sensitivity and specificity.For lesions with a diameter of less than 2 cm,the sensitivity of CECT/CEUS was significantly better than that of CECT and CEUS(p < 0.05).Fourteen lesions with a diameter of less than 2 cm which were detected by CUES were not detected by CT and 26 such lesions which were detected by CT were not detected by CUES.Conclusions: 1.Gd-EOB-DTPA-MRI performed as a routine check before surgery in HCC patients was conducive to improved detection of small lesions.2.The diagnostic efficacy of GD-EOB-DTPA-MRI and CEUS for liver lesions was similar,and the sensitivity and coincidence rate of the two methods were comparable,however,Gd-EOB-DTPA-MRI could detect more smaller intrahepatic lesions(diameter < 2 cm)than CEUS.3.CUES and CECT exhibited similar high sensitivity and diagnostic accuracy for HCC.A detection method that combines CT and CUES could find more small lesions in the liver.Part two Meta-analysis of Gd-EOB-DTPA-MRI、CECT and CEUS in the diagnosis of HCCObjective: 1.The objective was to assess the diagnostic performance of Gd-EOB-DTPA-MRI and CECT in HCC.2.The purpose of this study was to explore and compare the diagnostic performance of Gd-EOB-DTPA-MRI and CEUS in HCC.3.The purpose of this study was to compare and analyse the performance of CECT and CEUS in the diagnosis of HCC.Method: 1.Three conventional databases were searched from their establishment to January 8,2019,to find the literature on the comparison of the diagnostic performance of Gd-EOB-DTPA-MRI and CECT in the diagnosis of HCC.2.Pub Med,EMBASE,and Cochrane Library databases were searched to find studies on Gd-EOB-DTPA-MRI and CEUS in the diagnosis of HCC patients.3.Multiple databases were searched from their establishment to June24,2020,to search for literature pertaining to the comparison of the performance of CECT and CEUS in the diagnosis of HCC.Results: 1.A total of eight prospective studies were included,involving a total of 498 patients and 502 HCC lesions.The sensitivity of MRI was significantly higher that of CECT in diagnosis of HCC,0.85(0.77 to 0.90)and0.68(0.51 to 0.81),respectively,p < 0.05.The data were not significantly different in terms of the specificity of MRI and CT,0.94(0.88 to 0.97)v.0.93(0.84 to 0.96),respectively.In lesions with a diameter of less than 2 cm,the sensitivity of both MRI and CECT decreased,but the sensitivity of MRI was still significantly higher than that of CECT,with 0.79(0.67 to 0.87)and 0.46(0.32 to 0.61),respectively,p < 0.05.2.The study finally included eight studies which included 374 patients.The sensitivity of MRI was superior to that of CEUS in diagnostic of HCC.The diagnostic sensitivity of MRI for HCC was better than that of CEUS,especially for lesions with a diameter of less than 3 cm(p < 0.05).3.A total of eight prospective studies,including 990 patients,were included.The sensitivity and specificity of CEUS and CECT were 0.79 v.0.75 and 0.93 v.0.91,respectively,showing no significant difference.There were no significant differences in negative likelihood ratio,positive likelihood ratio,and diagnostic odds ratio between CEUS and CECT(0.22 v.0.27,11.8 v.8.0,and 53 v.29,respectively).Conclusion: 1.Gd-EOB-DTPA–MRI shows higher sensitivity than CECT in the diagnosis of HCC lesions,especially for lesions with a diameter of less than 2 cm.2.Gd-EOB-DTPA-MRI shows higher sensitivity than CEUS in the diagnosis of HCC lesions,especially for lesions with a diameter of less than 3cm.3.The detection performance of CEUS and CECT for hepatocellular carcinoma was similar.Overall conclusion: The three imaging methods(GD-EOB-DTPA-MRI,CECT,and CEUS)have high sensitivity and accuracy in the diagnosis of HCC and are good non-invasive diagnostic methods.The sensitivity of GD-EOB-DTPA-MRI is higher than that of CECT and CEUS for intrahepatic lesions with a diameter of 2 cm,and the specificity of the three is similar.The sensitivity and specificity of CECT and CEUS are similar,and the combination of CECT and CEUS is found to improve the detection of small lesions in the liver.