Beta-Catenin-Mutated Hepatocellular Adenomas at Hepatobiliary Phase MRI: A Systematic Review and Meta-Analysis

Background: Beta-catenin-mutated hepatocellular adenomas (beta-HCAs) can appear iso- to hyperintense at the hepatobiliary phase (HBP) at magnetic resonance imaging (MRI). Given the relatively lower prevalence of beta-HCAs, prior studies had limited power to show statistically significant differences in the HBP signal intensity between different subtypes. Purpose: To assess the diagnostic performance of HBP MRI to discriminate beta-HCA from other subtypes. Study Type: Systemic review and meta-analysis. Population: Ten original studies were included, yielding 266 patients with 397 HCAs (9%, 36/397 beta-HCAs and 91%, 361/397 non-beta-HCAs). Field Strength/Sequence: 1.5 T and 3.0 T, HBP. Assessment: PubMed, Web of Science, and Embase databases were searched from January 1, 2000, to August 31, 2023, for all articles reporting HBP signal intensity in patients with histopathologically proven HCA subtypes. QUADAS-2 was used to assess risk of bias and concerns regarding applicability. Statistical Tests: Univariate random-effects model was used to calculate pooled estimates. Heterogeneity estimates were assessed with I-2 heterogeneity index. Meta-regression (mixed-effect model) was used to test for differences in the prevalence of HBP signal between HCA groups. The threshold for statistical significance was set at P < 0.05. Results: HBP iso- to hyperintensity was associated with beta-HCAs (pooled prevalence was 72.3% in beta-HCAs and 6.3% in non-beta-HCAs). Pooled sensitivity and specificity were 72.3% (95% confidence interval 54.1-85.3) and 93.7% (93.8-97.7), respectively. Specificity had substantial heterogeneity with I-2 of 83% due to one study, but not for sensitivity (I-2 = 0). After excluding this study, pooled sensitivity and specificity were 77.4% (59.6-88.8) and 94.1% (88.9-96.9), with no substantial heterogeneity. One study had high risk of bias for patient selection and two studies were rated unclear for two domains. Data Conclusion: Iso- to hyperintensity at HBP MRI may help to distinguish beta-HCA subtype from other HCAs with high specificity. However, there was heterogeneity in the pooled estimates.