Multiphasic computed tomography (CT) and magnetic resonance imaging (MRI) are both used for noninvasive diagnosis of hepatocellular carcinoma (HCC) in patients with cirrhosis. To determine if there is a relative diagnostic benefit of one over the other, we synthesized evidence regarding the relative performance of CT, extracellular contrast–enhanced MRI, and gadoxetate‐enhanced MRI for diagnosis of HCC in patients with cirrhosis. We also assessed whether liver biopsy versus follow‐up with the same versus alternative imaging is best for CT‐indeterminate or MRI‐indeterminate liver nodules in patients with cirrhosis. We searched multiple databases from inception to April 27, 2016, for studies comparing CT with extracellular contrast–enhanced MRI or gadoxetate‐enhanced MRI in adults with cirrhosis and suspected HCC. Two reviewers independently selected studies and extracted data. Of 33 included studies, 19 were comprehensive, while 14 reported sensitivity only. For all tumor sizes, the 19 comprehensive comparisons showed significantly higher sensitivity (0.82 versus 0.66) and lower negative likelihood ratio (0.20 versus 0.37) for MRI over CT. The specificities of MRI versus CT (0.91 versus 0.92) and the positive likelihood ratios (8.8 versus 8.1) were not different. All three modalities performed better for HCCs ≥2 cm. Performance was poor for HCCs <1 cm. No studies examined whether adults with cirrhosis and an indeterminate nodule are best evaluated using biopsy, repeated imaging, or alternative imaging. Concerns about publication bias, inconsistent study results, increased risk of bias, and clinical factors precluded support for exclusive use of either gadoxetate‐enhanced or extracellular contrast–enhanced MRI over CT. Conclusion: CT, extracellular contrast–enhanced MRI, or gadoxetate‐enhanced MRI could not be definitively preferred for HCC diagnosis in patients with cirrhosis; in patients with cirrhosis and an indeterminate mass, there were insufficient data comparing biopsy to repeat cross‐sectional imaging or alternative imaging. (Hepatology 2018;67:401‐421).

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用于诊断肝细胞癌的影像学：系统评价和 Meta 分析

多相计算机断层扫描 (CT) 和磁共振成像 (MRI) 均用于肝硬化患者的肝细胞癌 (HCC) 的无创诊断。为了确定两者之间是否存在相对的诊断优势，我们综合了关于 CT、细胞外对比增强 MRI 和钆塞酸增强 MRI 诊断肝硬化患者 HCC 的相对性能的证据。我们还评估了肝活检与使用相同或替代成像的随访是否最适合肝硬化患者的 CT 不确定或 MRI 不确定的肝结节。我们检索了从成立到 2016 年 4 月 27 日的多个数据库，以比较 CT 与细胞外对比增强 MRI 或钆塞酸增强 MRI 在成人肝硬化和疑似 HCC 中的对比研究。两名评价员独立选择研究并提取数据。在纳入的 33 项研究中，19 项是综合性的，而 14 项仅报告了敏感性。对于所有肿瘤大小，19 项综合比较显示 MRI 比 CT 具有更高的敏感性（0.82 对 0.66）和更低的阴性似然比（0.20 对 0.37）。MRI 与 CT 的特异性（0.91 对 0.92）和阳性似然比（8.8 对 8.1）没有区别。对于≥2 cm 的 HCC，所有三种方式都表现更好。对于 <1 cm 的 HCC，性能较差。没有研究检查是否最好使用活检、重复成像或替代成像评估患有肝硬化和不确定结节的成人。担心发表偏倚、研究结果不一致、偏倚风险增加、和临床因素排除了仅使用钆塞酸盐增强或细胞外对比增强 MRI 而非 CT 的支持。结论：CT、细胞外对比增强 MRI 或钆塞酸增强 MRI 不能明确首选用于肝硬化患者的 HCC 诊断；在肝硬化和不确定肿块的患者中，没有足够的数据将活检与重复横断面成像或替代成像进行比较。（肝病学 2018 年；67：401-421）。没有足够的数据比较活检与重复横断面成像或替代成像。（肝病学 2018 年；67：401-421）。没有足够的数据比较活检与重复横断面成像或替代成像。（肝病学 2018 年；67：401-421）。