Comparison Of The Diagnostic Performance Of Contrast-enhanced Ultrasound With That Of Contrast-enhanced Computed Tomography And Diffusion Weighted Imaging In The Evaluation Of Portal Vein Tumor Thrombosis In Hepatocellular Carcinoma: A Meta-analysis

Background:Hepatocellular carcinoma(HCC)is the fifth commonest malignant tumors and third leading cause of malignant tumors death in the world.Up to 44% of HCC invade the portal vein and form portal vein tumor thrombosis(PVTT).The presence of PVTT affects the stage of HCC,treatment strategy and prognosis.Therefore,accurate evaluation of the benign and malignant portal vein thrombosis is essential for the treatment of HCC patients.The latest guidelines state that the diagnosis of HCC is confirmed by enhanced CT(CECT)or enhanced MR(CEMR)or pathological biopsy.But fine needle puncture biopsy has the risk of false negative and bleeding,and CECT has the disadvantages of ionizing radiation,renal toxicity,low spatial resolution,and MRI has the disadvantages of electromagnetic radiation,slow imaging,many contraindications,so their clinical application is limited.As a new imaging diagnosis technology,CEUS has the advantages of no ionizing radiation,easy operation,appropriate price,real-time dynamic imaging,and no renal toxicity,so it is widely used in the qualitative and localized diagnosis of PVTT.However,so far,no meta-analyses have evaluated the diagnostic abilities of CEUS,CECT and diffusion-weighted magnetic resonance imaging for detecting PVTT.PurposeTo compare the diagnostic accuracy of contrast-enhanced ultrasound(CEUS),contrast-enhanced computed tomography(CECT)and diffusion-weighted MRI(DWI) for detecting portal vein tumor thrombosis(PVTT)in a hepatocellular carcinoma(HCC)setting,to provide cost-effective imaging methods for the early diagnosis,the selection of treatment options and postoperative follow-up of HCC.Methods:Using "Portal Vein Thrombosis","CEUS","CECT" and "DWI" as key words,articles published from January 2005 to June 2020 in Pubmed,Embase,Cochrane Library,Sinomed and Wanfang database were searched.The literatures were searched according to the inclusion and exclusion criteria.If the studies confrom to the inclusion criteria,the numbers of the true positive,false negativ,false positiv,true negative and other basic characteristics were extracted.Result:A total of 24 related literatures were included in our study,including 28 original data.The sensitivity,specificity,positive likelihood ratio,negative likelihood ratio and diagnostic odds ratio of CEUS,CECT and DWI in the diagnosis of PVTT in HCC patients were 96%/82%/91% 、 99%/92%/71% 、 18.7/7.23/3.83 、 0.08/0.22/0.09 、403.9/45.10/44.97,respectively.And the area under the curve(AUC)of CEUS,CECT and DWI were 0.9875,0.9263 and 0.9482,respectively.Conculsion:CEUS,CECT and DWI are of high diagnostic value for PVTT in the context of HCC;The sensitivity and specificity of CEUS in the diagnosis of PVTT were slightly higher than that of CECT and DWI,and the diagnostic efficacy of the three diagnostic methods was similar.