The Efficacy Of GD-EOB-DTPA-enhanced MRI In Evaluating Liver Functional Reserve:A Meta-analysis

Background and AimsGadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid(Gd-EOB-DTPA),as a liver-specific magnetic resonance(MR)contrast agent,can be easily absorbed by functional hepatocytes and secreted into the biliary system.Due to these characteristics,MR imaging with Gd-EOB-DTPA has high application value in quantitative assessment of liver functional reserve.However,in the current literature,discordant opinions exist regarding the most effective parameter derived from Gd-EOB-DTPA-enhanced MRI for assessment of liver functional reserve.The purpose of this meta-analysis was aimed to compare the diagnostic performance of functional parameter derived from Gd-EOB-DTPA-enhanced MRI for evaluation of liver functional reserve,determined using the indocyanine green retention rate at 15 min(ICG-R15).Methods(1)Articles were included if they met the following criteria:a.performed in patients with any chronic liver disease such as chronic viral hepatitis,cirrhosis,and Hepatocellular carcinoma;b.investigated the correlation between ICG-R15 and the indices of Gd-EOB-DTPA-enhanced MRI for assessment of liver functional reserve;c.evaluated liver functional reserve by Gd-EOB-DTPA-enhanced MRI through the relative liver enhancement(RLE),liver-to-spleen ratio(LSR),liver-to-muscle ratio(LMR),reduction rate of T1 relaxation time(rrTl)one or more;d.provided necessary data to calculate correlation coefficient between ICG-R15 and the indices of MR.(2)Search methods:A systematic search was performed through PubMed/Medline,Embase,Cochrane Library,Web of Science.The relevant studies were published prior to 10 January 2020.References reported in the identified studies were manually crosschecked.(3)Study selection and data extraction:Observers screened the search literatures and reviewed relevant full texts to determine whether they met the inclusion criteria.The information extracted from each included publication,included the following data:author,the year of publication,study design,the number and mean age of the patients,MRI field strength,Pearson or Spearman correlation coefficient(r),the median time interval between ICG-R15 and MRI.(4)Quality assessment:Risk of bias and applicability were assessed separately by investigators using the revised Quality Assessment of Diagnostic Accuracy Studies(QUADAS-2)tool.(5)Data synthesis and analysis:Statistical manipulation was performed with the software R version 3.5.2.Pooled correlation coefficients were calculated by combining the r values obtained in the individual studies.Between-study heterogeneity was assessed by computing chi-square test(p value)and inconsistency index(I2).If significant heterogeneity was detected,a subgroup analysis was performed to further investigate the study heterogeneity.(6)Sensitivity analysis was used to test the stability of the results.The funnel plot and Egger's test were used to examine published bias.Results(1)A total of 11 studies including 927 patients were selected for meta-analysis.The included studies were published between 2009 and 2018.The most studied indices of Gd-EOB-DTPA-enhanced MR was LSR,for which there were 7 studies.The next well-studied MR indices was RLE with 5 studies in total.5 studies reported data on LMR and ICG-R15,with 332 participants.3 studies reported data on rrTl and ICG-R15,with 286 participants.(2)According to the results of QUADAS-2 scale,in general,selected studies were considered to be at low risk of bias and had good applicability(3)The pooled r between ICG-R15 and RLE,rrTl were-0.48(95%CI,-0.57?-0.39,p<0.05),-0.53(95%CI,-0.62?-0.42,p<0.05),without statistically significant heterogeneity.The pooled r between ICG-R15 and LSR,LMR were-0.45(95%CI,-0.55?-0.34,p<0.05),-0.53(95%CI,-0.64?-0.39,p<0.05)with significant heterogeneity(p<0.001)..Subgroup analysis indicated that publication time was one of the sources of heterogeneity in analyses of LSR and ICG-R15.Sensitivity analysis,suggested that the outcome was stable.The distribution funnel plots and the results of Egger's test showed no evidence of publication bias.ConclusionsLiver functional reserve can be quantitatively evaluated by RLE,LSR,LMR,rrTl of Gd-EOB-DTPA-enhanced MRI.Among them,LMR and rrT1 have the same efficacy in evaluating liver functional reserve and are superior to RLE and LSR.