The diagnostic value of Gd-EOB-DTPA-MRI for the diagnosis of focal nodular hyperplasia: a systematic review and meta-analysis

We aimed to systematically review the gadoxetic acid-enhanced magnetic resonance imaging (Gd-EOB-DTPA-MRI) findings of focal nodular hyperplasia (FNH) and its diagnostic value. A thorough literature search was conducted in Ovid-MEDLINE and EMBASE databases to identify studies evaluating Gd-EOB-DTPA-MRI findings of FNH. To evaluate the frequency of characteristic imaging findings on Gd-EOB-DTPA-MRI, pooled proportions of high/iso signal intensity (SI) on the hepatobiliary phase (HBP), arterial enhancement, high/iso SI on the portal-venous phase (PVP) or equilibrium phase (EP), and the central scar were calculated. Meta-analysis was performed to evaluate the diagnostic accuracy of high/iso SI on HBP for distinguishing FNH from hepatocellular adenoma. A review of 96 articles identified ten eligible articles with 304 patients with FNHs for meta-analysis. Pooled proportion of the Gd-EOB-DTPA-MRI findings showed that high/iso SI on the HBP, arterial enhancement, and high/iso SI on the PVP/EP were observed in 93% (95% CI, 90–97%), 99% (95% CI, 97–100%), and 97% (95% CI, 95–99%) of FNHs, respectively, while a central scar was observed in 61% of FNHs (95% CI, 47–74%). High/iso SI on the HBP was highly accurate for distinguishing FNH from hepatocellular adenoma, with a summary sensitivity of 93.9% (95% CI, 89.1–97.1%) and a specificity of 95.3% (95% CI, 88.4–98.7%). High/iso SI on the HBP of Gd-EOB-DTPA-MRI is characteristic and a prevalent finding of FNHs and can be helpful in the management of patients with FNH. • The vast majority (94–97 %) of FNHs show high/iso SI on HBP. • High/iso SI on HBP was accurate for distinguishing FNH from hepatocellular adenoma. • HBP of Gd-EOB-DTPA-MRI can reduce unnecessary biopsies for the diagnosis of FNHs.