Abstract：
BACKGROUND. Accumulating evidence indicates that hepatocellular adenoma (HCA) may have a higher frequency of hepatobiliary phase (HBP) iso- or hyperintensity than previously reported. OBJECTIVE. The purpose of this study was to evaluate the proportion of HCA that shows iso- or hyperintensity in the HBP of gadoxetic acid-enhanced MRI, stratified by HCA subtype (HNF1a-inactivated [H-HCA], inflammatory [I-HCA], β-catenin-activated [B-HCA], and unclassified [U-HCA] HCA), and to assess the diagnostic performance of HBP iso- or hyperintensity for differentiating focal nodular hyperplasia (FNH) from HCA. EVIDENCE ACQUISITION. PubMed, Embase, and Cochrane Central Register of Controlled Trials were searched through February 14, 2022, for articles reporting HBP signal intensity on gadoxetic acid-enhanced MRI among pathologically proven HCAs, stratified by subtype. The pooled proportion of HBP iso- or hyperintensity was determined for each subtype and compared using metaregression. Diagnostic performance of HBP iso- or hyperintensity for differentiating FNH from all HCA subtypes combined and from B-HCA and U-HCA combined was assessed using bivariate modeling. EVIDENCE SYNTHESIS. Twenty-eight studies (12 original investigations, 16 case reports or case series) were included, yielding 364 patients with 410 HCAs (112 H-HCAs, 203 I-HCAs, 33 B-HCAs, 62 U-HCAs). Pooled proportion of HBP iso- or hyperintensity was 14% (95% CI, 4-26%) among all HCAs, 0% (95% CI, 0-2%) among H-HCAs, 11% (95% CI, 0-29%) among U-HCAs, 14% (95% CI, 2-31%) among I-HCAs, and 59% (95% CI, 26-88%) among B-HCAs; metaregression showed significant difference among subtypes (p < .001). In four studies reporting diagnostic performance information, HBP iso- or hyperintensity had sensitivity of 99% (95% CI, 57-100%) and specificity of 89% (95% CI, 82-94%) for differentiating FNH from all HCA subtypes and sensitivity of 99% (95% CI, 53-100%) and specificity of 65% (95% CI, 44-80%) for differentiating FNH from B-HCA or U-HCA. CONCLUSION. HCA subtypes other than H-HCA show proportions of HBP iso- or hyperintensity ranging from 11% (U-HCA) to 59% (B-HCA). Low prevalence of B-HCA has contributed to prior reports of high diagnostic performance of HBP iso- or hyperintensity for differentiating FNH from HCA. CLINICAL IMPACT. Radiologists should recognize the low specificity of HBP iso- or hyperintensity on gadoxetic acid-enhanced MRI for differentiating FNH from certain HCA subtypes.
摘要：
背景。越来越多的证据表明，肝细胞腺瘤（HCA）的肝胆相（HBP）等强度或高强度频率可能高于以前的报道。目标。这项研究的目的是评估在gadoxetic酸增强MRI的HBP中显示等强度或高强度的HCA的比例，按HCA亚型分层(HNF1a灭活的[H-HCA]，炎性[I-HCA]，β-连环蛋白激活的[B-HCA]，和未分类的[U-HCA]HCA)，并评估HBP等强度或高强度的诊断性能，以区分局灶性结节增生（FNH）和HCA。证据获取。PubMed,Embase,和Cochrane中央对照试验登记册被搜索到2022年2月14日，在病理证实的HCA中报告gadoxetic酸增强MRI上HBP信号强度的文章，按亚型分层。确定每种亚型的HBP等强度或高强度的合并比例，并使用回归进行比较。使用双变量模型评估HBP等强度或高强度对FNH与所有组合的HCA亚型以及B-HCA和U-HCA组合的诊断性能。证据综合.28项研究(12项原始调查，包括16例病例报告或病例系列)，产生364名患有410HCA（112H-HCA，203I-HCA，33B-HCA，62U-HCA）。在所有HCA中，HBP等强度或高强度的汇集比例为14%(95%CI，4-26%)，0%（95%CI，0-2%）的H-HCA，11%（95%CI，0-29%），I-HCA中的14%（95%CI，2-31%），和59％（95％CI，26-88％）在B-HCA中；元回归显示出亚型之间的显着差异（p<.001）。在报告诊断性能信息的四项研究中，HBP等强度或高强度的敏感性为99％（95％CI，57-100％），特异性为89％（95％CI，82-94％），将FNH与所有HCA亚型区分开来，敏感性为99％（95％CI，53-100％），特异性为65％（95％CI，44-80％）。结论。H-HCA以外的HCA亚型显示HBP等强度或高强度的比例为11%(U-HCA)至59%(B-HCA)。B-HCA的低患病率导致先前报道HBP等强度或高强度的高诊断性能，以区分FNH和HCA。临床影响。放射科医师应认识到在gadoxetic酸增强MRI上HBP等强度或高强度的低特异性，可将FNH与某些HCA亚型区分开。
