Diagnostic performance of diffusion-weighted imaging with quantitative apparent diffusion coefficient for detecting residual or recurrent hepatocellular carcinoma after TACE: a meta-analysis.

BACKGROUND: Accurate detection of residual or recurrent hepatocellular carcinoma (HCC) after transarterial chemoembolization (TACE) is critical for guiding subsequent management but remains challenging with conventional imaging. Diffusion-weighted imaging (DWI) with quantitative apparent diffusion coefficient (ADC) has emerged as a functional MRI technique that may improve diagnostic accuracy in this setting, though evidence remains heterogeneous. OBJECTIVE: To assess the diagnostic performance of DWI combined with quantitative ADC for identifying residual or recurrent HCC following TACE. METHODS: A literature search of PubMed, Embase, Web of Science, and the Cochrane Library was conducted for studies published up to September 2025. Pooled estimates for sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and summary receiver operating characteristic (SROC) curve metrics were derived using a bivariate random-effects model to account for anticipated heterogeneity. RESULTS: The meta-analysis included 16 studies, encompassing 818 patients and 971 lesions. The pooled sensitivity was 0.78 (95% CI: 0.70-0.85), and the pooled specificity was 0.83 (95% CI: 0.77-0.87). The pooled PLR was 4.53 (95% CI: 3.28-6.26), the NLR was 0.26 (95% CI: 0.18-0.37), and the DOR was 13.89 (95% CI: 8.46-22.82). The area under the SROC curve was 0.88 (95% CI: 0.85-0.90). Subgroup analysis indicated that the diagnostic accuracy (AUC) was significantly higher in prospective studies compared to retrospective studies. CONCLUSIONS: DWI with quantitative ADC demonstrates good overall diagnostic accuracy for detecting residual or recurrent HCC after TACE. The technique offers moderate-to-high specificity but more modest sensitivity, and should currently be considered a complementary adjunct to conventional imaging rather than a standalone replacement. REGISTRATION: The review protocol was registered on INPLASY platform (Registration number: INPLASY2025100047).