Diagnostic accuracy of elastography and magnetic resonance imaging in patients with NAFLD: A systematic review and meta-analysis

JOURNAL OF HEPATOLOGY

卷:75

Review

Selvaraj, Emmanuel Anandraj^1,2,3,4  Mozes, Ferenc Emil¹  Jayaswal, Arjun Narayan Ajmer¹  Zafarmand, Mohammad Hadi⁵  Vali, Yasaman⁵  Lee, Jenny A.⁵  Levick, Christina Kim¹  Young, Liam Arnold Joseph¹  Palaniyappan, Naaventhan^6,7  Liu, Chang-Hai^8,10,9  Aithal, Guruprasad Padur^6,7  Romero-Gomez, Manuel⁸  Brosnan, M. Julia¹¹  Tuthill, Theresa A.¹¹  Anstee, Quentin M.^12,13  Neubauer, Stefan¹  Harrison, Stephen A.¹  Bossuyt, Patrick M.⁵  Pavlides, Michael^1,2,3,4 

[1] Univ Oxford, Radcliffe Dept Med, Oxford Ctr Clin Magnet Resonance Res, Oxford, England

[2] Univ Oxford, Nuffield Dept Med, Translat Gastroenterol Unit, Oxford, England

[3] Oxford Univ Hosp NHS Fdn Trust, NIHR Oxford Biomed Res Ctr, Oxford, England

[4] Univ Oxford, Oxford, England

[5] Univ Amsterdam, Amsterdam UMC, Dept Epidemiol & Data Sci, Amsterdam, Netherlands

[6] Nottingham Univ Hosp NHS Trust, NIHR Nottingham Biomed Res Ctr, Nottingham, England

[7] Univ Nottingham, Nottingham, England

[8] Univ Seville, Virgen Rocio Univ Hosp, UCM Digest Dis, Inst Biomed Seville, Seville, Spain

[9] Sichuan Univ, West China Hosp, Ctr Infect Dis, Chengdu, Peoples R China

[10] Sichuan Univ, West China Hosp, Div Infect Dis, State Key Lab Biotherapy, Chengdu, Peoples R China

[11] Pfizer Inc, Internal Med Res Unit, Cambridge, MA USA

[12] Newcastle Univ, Fac Med Sci, Liver Res Grp Translat & Clin Res Inst, Newcastle Upon Tyne, Tyne & Wear, England

[13] Newcastle Upon Tyne Hosp, NHS Fdn Trust, NIHR Newcastle Biomed Res Ctr, Newcastle Upon Tyne, Tyne & Wear, England

关键词: Non-alcoholic fatty liver disease;    Non-alcoholic steatohepatitis;    Bio-markers;    Liver fibrosis;    Transient elastography;    Shear wave elastography;    Magnetic resonance elastography;    Iron-corrected T1;    Diffusion-weighted imaging;    deMILI;    fibro-MRI;    NASH-MRI;   

DOI  :  10.1016/j.jhep.2021.04.044

来源: Elsevier

【 摘 要 】

Background and Aims: Vibration-controlled transient elastography (VCTE), point shear wave elastography (pSWE), 2 dimensional shear wave elastography (2DSWE), magnetic resonance elastography (MRE), and magnetic resonance imaging (MRI) have been proposed as non-invasive tests for patients with non-alcoholic fatty liver disease (NAFLD). This study evaluated their diagnostic accuracy for liver fibrosis and non-alcoholic steatohepatitis (NASH). Methods: PubMED/MEDLINE, EMBASE and the Cochrane Library were searched for studies examining the diagnostic accuracy of these index tests, against histology as the reference standard, in adult patients with NAFLD. Two authors independently screened and assessed methodological quality of studies and extracted data. Summary estimates of sensitivity, specificity and area under the curve (sAUC) were calculated for fibrosis stages and NASH, using a random effects bivariate logit-normal model. Results: We included 82 studies (14,609 patients). Meta-analysis for diagnosing fibrosis stages was possible in 53 VCTE, 11 MRE, 12 pSWE and 4 2DSWE studies, and for diagnosing NASH in 4 MRE studies. sAUC for diagnosis of significant fibrosis were: 0.83 for VCTE, 0.91 for MRE, 0.86 for pSWE and 0.75 for 2DSWE. sAUC for diagnosis of advanced fibrosis were: 0.85 for VCTE, 0.92 for MRE, 0.89 for pSWE and 0.72 for 2DSWE. sAUC for diagnosis of cirrhosis were: 0.89 for VCTE, 0.90 for MRE, 0.90 for pSWE and 0.88 for 2DSWE. MRE had sAUC of 0.83 for diagnosis of NASH. Three (4%) studies reported intention-to-diagnose analyses and 15 (18%) studies reported diagnostic accuracy against pre specified cut-offs. Conclusions: When elastography index tests are acquired successfully, they have acceptable diagnostic accuracy for advanced fibrosis and cirrhosis. The potential clinical impact of these index tests cannot be assessed fully as intention-to-diagnose analyses and validation of pre-specified thresholds are lacking. Lay summary: Non-invasive tests that measure liver stiffness or use magnetic resonance imaging (MRI) have been suggested as alternatives to liver biopsy for assessing the severity of liver scarring (fibrosis) and fatty inflammation (steatohepatitis) in patients with non-alcoholic fatty liver disease (NAFLD). In this study, we summarise the results of previously published studies on how accurately these non-invasive tests can diagnose liver fibrosis and inflammation, using liver biopsy as the reference. We found that some techniques that measure liver stiffness had a good performance for the diagnosis of severe liver scarring. (C) 2021 The Author(s). Published by Elsevier B.V. on behalf of European Association for the Study of the Liver.

【 授权许可】

Free