Gadoxetic acid-enhanced magnetic resonance imaging for the detection of small hepatocellular carcinoma (≤ 2.0 cm) in patients with chronic liver disease: A meta-analysis

Figure 1 Flow chart for articles identified and included in this meta-analysis. HCC: Hepatocellular carcinoma.

Figure 2 Grouped bar charts showing results of study quality assessment with the QUADAS-2 tool. The charts show the cumulative results of the 10 included studies in terms of risk of bias (left) and concerns regarding applicability (right) according to each QUADAS-2 domain.

Figure 3 Results of Deeks’ funnel plot asymmetry test for publication bias. The nonsignificant slope indicates that no significant bias was found. ESS: Effective sample size (P = 0.23).

Figure 4 Forest plot of pooled sensitivity and specificity of gadoxetic acid-enhanced magnetic resonance imaging in detecting small hepatocellular carcinoma among patients with chronic liver disease. Summary sensitivity and specificity were 0.91 (95%CI: 0.83-0.95) and 0.95 (95%CI: 0.87-0.98), respectively.

Figure 5 Scattergram of positive likelihood ratio and negative likelihood ratio. Pooled estimates for gadoxetic acid-enhanced MRI in the detection of small HCC were: PLR of 18.1 (95%CI: 6.6-49.4) and NLR of 0.10 (95%CI: 0.05-0.19). PLR: Positive likelihood ratio; NLR: Negative likelihood ratio.

Figure 6 Hierarchical summary receiver operating characteristic plot of per-lesion diagnostic accuracy for gadoxetic acid-enhanced magnetic resonance imaging detection of small hepatocellular carcinoma in patients with chronic liver disease for the 10 included studies. The 95% confidence region and 95% prediction region around the pooled estimates illustrate the precision with which the pooled values were estimated (confidence ellipse of a mean) and to show the extent of between-study variation (prediction ellipse; likely range of values for a new study). HSROC: Hierarchical summary receiver operator characteristic.