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European Radiology

, Volume 29, Issue 10, pp 5205–5216 | Cite as

Detection of liver metastases on gadobenate dimeglumine-enhanced MRI: systematic review, meta-analysis, and similarities with gadoxetate-enhanced MRI

  • Ling Zhang
  • Xian Yu
  • Lei Huo
  • Lun Lu
  • Xinpeng Pan
  • Ningyang JiaEmail author
  • Xinxiang FanEmail author
  • Giovanni Morana
  • Luigi Grazioli
  • Guenther Schneider
Contrast Media

Abstract

Objectives

To determine the sensitivity and positive predictive value (PPV) of gadobenate-enhanced MR imaging for the detection of liver metastases.

Methods

This systematic review and meta-analysis was conducted according to PRISMA guidelines. A comprehensive search (EMBASE, PubMed) was performed to identify relevant articles up to December 2017. Studies eligible for inclusion were performed using appropriate methodology with complete verification by means of histopathology, intraoperative observation and/or follow-up, and sufficient information to permit determination of true-positive (TP), false-negative (FN), and false-positive (FP) values. Sources of bias were assessed using the QUADAS-2 tool. An inverse variance-weighted random-effects model was used to obtain sensitivity and PPV estimates. Information was analyzed and presented using Cochran’s Q statistic, funnel plots, and modified Deeks’ analysis.

Results

Ten articles (256 patients, 562 metastases) were included. Sensitivity estimates for pre-contrast (unenhanced) imaging, gadobenate-enhanced dynamic imaging, and combined unenhanced, dynamic, and delayed hepatobiliary phase imaging for detecting liver metastases on a per-lesion basis were 77.8% (95% CI 71.4–84.3%, 7 assessments), 88.1% (95% CI, 84.0–92.2%, 13 assessments), and 95.1% (95% CI 93.1–97.1%, 15 assessments), respectively. The addition of hepatobiliary phase images significantly improved the detection of liver metastases. The overall PPV was 90.9% (95% CI 86.6–95.1%, 11 assessments). Deeks’ funnel analysis revealed no association between sample size and sensitivity (β = 0.02, p = 0.814) indicating no significant publication bias.

Conclusions

Gadobenate-enhanced MR imaging has high sensitivity and PPV for the detection of liver metastases on a per-lesion basis. The sensitivity and PPV for detection is comparable to reported values for the pure liver-specific agent gadoxetate.

Key Points

• Gadobenate dimeglumine is a hepatobiliary MR contrast agent that permits acquisition of contrast-enhanced liver images during the immediate post-injection dynamic phase, like any extracellular agent, and in the delayed hepatobiliary phase, after specific uptake by the hepatocytes.

• The hepatobiliary phase improves detection of liver metastases when compared either to pre-contrast unenhanced images alone or to pre-contrast + gadobenate-enhanced dynamic phase images.

• The meta-analysis showed an overall sensitivity of 95.1% and PPV of 90.9% of gadobenate-enhanced MRI for the detection of metastases, when based on the evaluation of all available acquisitions.

Keywords

Gadobenate dimeglumine (MultiHance) Liver MRI Liver metastases Meta-analysis 

Abbreviations

CI

Confidence interval

DWI

Diffusion-weighted imaging

FN

False negative

FP

False positive

GBCA

Gadolinium-based contrast agent

IOUS

Intraoperative ultrasound

MRI

Magnetic resonance imaging

NAC

Neoadjuvant chemotherapy

PET/CT

Positron emission tomography/computerized tomography

PPV

Positive predictive value

PRISMA

Preferred reporting items for systematic reviews and meta-analyses

QUADAS

Quality assessment of diagnostic accuracy studies

TP

True positive

Notes

Funding

The authors state that this work has not received any funding.

Compliance with ethical standards

Guarantor

The scientific guarantor of this publication is Hongyan Chen.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise.

Informed consent

Written informed consent was not required for this study because it is a meta-analysis on published literature.

Ethical approval

Institutional Review Board approval was not required because it is a meta-analysis on published literature.

Methodology

• retrospective

• diagnostic study

• performed at one institution

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Copyright information

© European Society of Radiology 2019

Authors and Affiliations

  • Ling Zhang
    • 1
  • Xian Yu
    • 2
  • Lei Huo
    • 3
  • Lun Lu
    • 3
  • Xinpeng Pan
    • 3
  • Ningyang Jia
    • 3
    Email author
  • Xinxiang Fan
    • 4
    Email author
  • Giovanni Morana
    • 5
  • Luigi Grazioli
    • 6
  • Guenther Schneider
    • 7
  1. 1.Department of Radiology, Nanfang HospitalSouthern Medical UniversityGuangzhouChina
  2. 2.Department of gastrointestinal surgeryChongqing University Cancer Hospital & Chongqing Cancer Institute & Chongqing Cancer HospitalChongqingChina
  3. 3.Department of Radiology, Shanghai Eastern Hepatobiliary Surgery HospitalSecond Military Medical UniversityShanghaiChina
  4. 4.Department of Urology, Sun Yat-sen Memorial HospitalSun Yat-sen UniversityGuangzhouChina
  5. 5.Department of RadiologyOspedale Ca’ FoncelloTrevisoItaly
  6. 6.Department of RadiologyUniversity of Brescia, Ospedale “Spedali Civili”BresciaItaly
  7. 7.Department of RadiologySaarland University Medical CenterHomburgGermany

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