Diagnostic performance of MRI using extracellular contrast agents versus gadoxetic acid for hepatocellular carcinoma: A systematic review and meta‐analysis

Abstract Background & Aims Magnetic resonance imaging (MRI) is the first‐line tool for the noninvasive diagnosis of hepatocellular carcinoma (HCC) in patients with chronic liver diseases. We performed a meta‐analysis to compare the performance of MRI using extracellular contrast agents (ECA‐MRI) with that using gadoxetic acid (EOB‐MRI) for diagnosing HCC. Methods We searched multiple databases for studies comparing the diagnostic performance of ECA‐MRI with that of EOB‐MRI in patients with suspected HCC until 31 May 2020. The bivariate random‐effects model was used to pool the performance and further subgroup analysis was performed. Results Eight studies were included evaluating a total of 1002 patients. ECA‐MRI revealed significantly higher per‐lesion sensitivity in the diagnosis of HCC than EOB‐MRI did (0.76 vs 0.63, P = .002). For modified EOB‐MRI (mEOB‐MRI) using extended washout to the transitional phase (TP) or hepatobiliary phase (HBP), the sensitivity increased compared with that of EOB‐MRI using restrictive washout in the portal venous phase (PVP) (0.74 vs 0.63, P = .07). No significant difference among the specificities of ECA‐MRI, EOB‐MRI, and mEOB‐MRI (0.96, 0.98, and 0.93, respectively) was found. The sensitivity for lesions < 20 mm was significantly lower than that for lesions ≥ 20mm (0.66 vs 0.87, P = .01) only for ECA‐MRI, which achieved higher sensitivity in Asian patients or with a 3.0 T scanner. Conclusions ECA‐MRI outperforms EOB‐MRI in per‐lesion sensitivity for diagnosing HCC, whereas mEOB‐MRI shows a trend towards improved sensitivity compared with EOB‐MRI with slightly decreased specificity. Registration: Prospero CRD42020189680.