Contrast-enhanced US for characterization of focal liver lesions: a comprehensive meta-analysis

• Published in: European radiology 2018-05, Vol.28 (5), p.2077-2088
• Main Authors: Wu, Menglin, Li, Liang, Wang, Jiahui, Zhang, Yanyan, Guo, Qi, Li, Xue, Zhang, Xuening
• Format: Article
• Language: English
• Subjects: Accuracy; Benign; Bias; Contingency; Contrast agents; Contrast Media - pharmacology; Data processing; Diagnosis, Differential; Diagnostic Radiology; Diagnostic systems; Humans; Imaging; Internal Medicine; Interventional Radiology; Lesions; Liver; Liver - diagnostic imaging; Liver cancer; Liver Diseases - diagnosis; Malignancy; Medical diagnosis; Medicine; Medicine & Public Health; Meta-analysis; Neuroradiology; Original Article; Quality assessment; Radiology; Regression analysis; Ultrasonography - methods; Ultrasound
• ISSN: 0938-7994; 1432-1084
• DOI: 10.1007/s00330-017-5152-x

Objectives This meta-analysis was performed to evaluate the accuracy of contrast-enhanced ultrasound (CEUS) in differentiating malignant from benign focal liver lesions (FLLs). Methods Cochrane Library, PubMed and Web of Science databases were systematically searched and checked for studies using CEUS in characterization of FLLs. Data necessary to construct 2×2 contingency tables were extracted from included studies. The QUADAS tool was utilized to assess the methodologic quality of the studies. Meta-analysis included data pooling, subgroup analyses, meta-regression and investigation of publication bias was comprehensively performed. Results Fifty-seven studies were included in this meta-analysis and the overall diagnostic accuracy in characterization of FLLs was as follows: pooled sensitivity, 0.92 (95%CI: 0.91–0.93); pooled specificity, 0.87 (95%CI: 0.86–0.88); diagnostic odds ratio, 104.20 (95%CI: 70.42–154.16). Subgroup analysis indicated higher diagnostic accuracy of the second-generation contrast agents (CAs) than the first-generation CA (Levovist; DOR: 118.27 vs. 62.78). Furthermore, Sonazoid demonstrated the highest diagnostic accuracy among three major CAs (SonoVue, Levovist and Sonazoid; DOR: 118.82 vs. 62.78 vs. 227.39). No potential publication bias was observed of the included studies. Conclusion CEUS is an accurate tool to stratify the risk of malignancy in FLLs. The second-generation CAs, especially Sonazoid may greatly improve diagnostic performance. Key Points • CEUS shows excellent diagnostic accuracy in differentiating malignant from benign FLLs. • The second-generation CAs have higher diagnostic accuracy than first-generation CAs. • Sonazoid demonstrates the highest diagnostic accuracy among three major CAs.