Assessing diagnostic value of contrast-enhanced ultrasound and contrast-enhanced computed tomography in detecting small hepatocellular carcinoma: A meta-analysis

BACKGROUND: This study aimed to compare the diagnostic values of contrast-enhanced ultrasound (CEUS) and contrast-enhanced computed tomography (CECT) in detecting small hepatocellular carcinoma (SHCC). METHODS: A series of related articles from 2001 to 2015 were searched in PubMed and Embase databases. Data from selected articles were pooled to analyze the sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and summary receiver operating characteristic (SROC) curve using Meta-DiSc software. Heterogeneity was estimated using χ(2)-based Cochran-Q test and I(2)-statistics, and publication bias was estimated using Egger test in Stata software. RESULTS: In total, 8 high-quality articles based on 623 subjects including 318 SHCC cases were included. For the extracted data, no heterogeneity and publication bias were observed among these studies. The following respective data on CEUS and CECT were pooled: sensitivities: 0.75 (95% confidence interval [CI]: 0.70–0.80) and 0.74 (95% CI: 0.68–0.78); specificity: 0.91 (95% CI: 0.87–0.94) and 0.92 (95% CI: 0.89–0.95); PLRs: 5.99 (95%CI: 3.28–10.92) and 7.76 (95% CI: 3.12–19.28); NLRs: 0.31 (95% CI: 0.20–0.49) and 0.32 (95% CI: 0.20–0.50); DORs: 27.38 (95% CI: 14.38–52.11) and 30.02 (95% CI: 9.32–96.62). Area under the SROC curve: 0.91 and 0.89 and no significant statistical result was identified between them (Z = 0.23, P = .82). CONCLUSION: CEUS showed a diagnostic ability comparable to that of CECT in detecting SHCC.