Diagnostic value of contrast-enhanced ultrasound in hepatocellular carcinoma: a meta-analysis with evidence from 1998 to 2016

Background: This meta-analysis is aimed at determining the diagnostic value of hepatocellular carcinoma (HCC) with contrast-enhanced ultrasound (CEUS). Materials and Methods: A comprehensive literature search of Pubmed, Web of Science, and the Cochrane Library was performed to identify published studies. The methodological quality of the included studies was evaluated. Data from eligible studies were used to estimate the pooled sensitivity, specificity, diagnostic odds ratio (DOR), positive and negative likelihood ratio (LR) and summary receiver operating characteristic (SROC) curve. Meta-Disc and STATA softwares were utilized for all statistical analyses. Results: Fifty-three eligible studies (publication years ranged from 1998 to 2016) were selected according to inclusion criteria. The meta-analysis showed that the pooled sensitivity and specificity of CEUS to detect HCC were 0.85 (95% CI: 0.84-0.86) and 0.91 (95% CI: 0.90-0.92), respectively. The pooled positive and negative LRs were 6.28 (95% CI: 4.49-8.77) and 0.16 (95% CI: 0.12-0.22), respectively. The pooled DOR was 55.01 (95% CI: 35.25-83.47). The area under the SCOR curve was 0.9432. Meta-regression and funnel plot indicated that sample size, type of contrast agents and publication bias might be the major sources of heterogeneity. Conclusions: CEUS is a valuable diagnostic tool for identifying HCC in clinic with highly sensitive and specific.