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

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-al...

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Autores: Selvaraj, Emmanuel Anandraj, Mozes, Ferenc Emil, Ajmer Jayaswal, Arjun Narayan, Zafarmand, Mohammad Hadi, Vali, Yasaman, Lee, Jenny A., Romero Gómez, Manuel, Ampuero Herrojo, Javier, Gómez-González, Emilio
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2021
País:España
Institución:Universidad de Sevilla (US)
Repositorio:idUS. Depósito de Investigación de la Universidad de Sevilla
OAI Identifier:oai:idus.us.es:11441/139090
Acceso en línea:https://hdl.handle.net/11441/139090
https://doi.org/10.1016/j.jhep.2021.04.044
Access Level:acceso abierto
Palabra clave:Non-alcoholic fatty liver disease
Non-alcoholic steatohepatitis
Biomarkers
Liver fibrosis
Transient elastography
Shear wave elastography
Magnetic resonance elastography
Iron-corrected T1
Diffusion-weighted imaging
deMILI
fibro-MR
NASH-MRI
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spelling Diagnostic accuracy of elastography and magnetic resonance imaging in patients with NAFLD: a systematic review and meta-analysisSelvaraj, Emmanuel AnandrajMozes, Ferenc EmilAjmer Jayaswal, Arjun NarayanZafarmand, Mohammad HadiVali, YasamanLee, Jenny A.Romero Gómez, ManuelAmpuero Herrojo, JavierGómez-González, EmilioNon-alcoholic fatty liver diseaseNon-alcoholic steatohepatitisBiomarkersLiver fibrosisTransient elastographyShear wave elastographyMagnetic resonance elastographyIron-corrected T1Diffusion-weighted imagingdeMILIfibro-MRNASH-MRIBackground 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 prespecified 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.MedicinaFísica Aplicada III2021info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfapplication/pdfhttps://hdl.handle.net/11441/139090https://doi.org/10.1016/j.jhep.2021.04.044reponame:idUS. Depósito de Investigación de la Universidad de Sevillainstname:Universidad de Sevilla (US)Ingléshttps://www.sciencedirect.com/science/article/pii/S0168827821003093?via%3Dihubinfo:eu-repo/semantics/openAccessoai:idus.us.es:11441/1390902026-06-17T12:51:07Z
dc.title.none.fl_str_mv Diagnostic accuracy of elastography and magnetic resonance imaging in patients with NAFLD: a systematic review and meta-analysis
title Diagnostic accuracy of elastography and magnetic resonance imaging in patients with NAFLD: a systematic review and meta-analysis
spellingShingle Diagnostic accuracy of elastography and magnetic resonance imaging in patients with NAFLD: a systematic review and meta-analysis
Selvaraj, Emmanuel Anandraj
Non-alcoholic fatty liver disease
Non-alcoholic steatohepatitis
Biomarkers
Liver fibrosis
Transient elastography
Shear wave elastography
Magnetic resonance elastography
Iron-corrected T1
Diffusion-weighted imaging
deMILI
fibro-MR
NASH-MRI
title_short Diagnostic accuracy of elastography and magnetic resonance imaging in patients with NAFLD: a systematic review and meta-analysis
title_full Diagnostic accuracy of elastography and magnetic resonance imaging in patients with NAFLD: a systematic review and meta-analysis
title_fullStr Diagnostic accuracy of elastography and magnetic resonance imaging in patients with NAFLD: a systematic review and meta-analysis
title_full_unstemmed Diagnostic accuracy of elastography and magnetic resonance imaging in patients with NAFLD: a systematic review and meta-analysis
title_sort Diagnostic accuracy of elastography and magnetic resonance imaging in patients with NAFLD: a systematic review and meta-analysis
dc.creator.none.fl_str_mv Selvaraj, Emmanuel Anandraj
Mozes, Ferenc Emil
Ajmer Jayaswal, Arjun Narayan
Zafarmand, Mohammad Hadi
Vali, Yasaman
Lee, Jenny A.
Romero Gómez, Manuel
Ampuero Herrojo, Javier
Gómez-González, Emilio
author Selvaraj, Emmanuel Anandraj
author_facet Selvaraj, Emmanuel Anandraj
Mozes, Ferenc Emil
Ajmer Jayaswal, Arjun Narayan
Zafarmand, Mohammad Hadi
Vali, Yasaman
Lee, Jenny A.
Romero Gómez, Manuel
Ampuero Herrojo, Javier
Gómez-González, Emilio
author_role author
author2 Mozes, Ferenc Emil
Ajmer Jayaswal, Arjun Narayan
Zafarmand, Mohammad Hadi
Vali, Yasaman
Lee, Jenny A.
Romero Gómez, Manuel
Ampuero Herrojo, Javier
Gómez-González, Emilio
author2_role author
author
author
author
author
author
author
author
dc.contributor.none.fl_str_mv Medicina
Física Aplicada III
dc.subject.none.fl_str_mv Non-alcoholic fatty liver disease
Non-alcoholic steatohepatitis
Biomarkers
Liver fibrosis
Transient elastography
Shear wave elastography
Magnetic resonance elastography
Iron-corrected T1
Diffusion-weighted imaging
deMILI
fibro-MR
NASH-MRI
topic Non-alcoholic fatty liver disease
Non-alcoholic steatohepatitis
Biomarkers
Liver fibrosis
Transient elastography
Shear wave elastography
Magnetic resonance elastography
Iron-corrected T1
Diffusion-weighted imaging
deMILI
fibro-MR
NASH-MRI
description 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 prespecified 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.
publishDate 2021
dc.date.none.fl_str_mv 2021
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://hdl.handle.net/11441/139090
https://doi.org/10.1016/j.jhep.2021.04.044
url https://hdl.handle.net/11441/139090
https://doi.org/10.1016/j.jhep.2021.04.044
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv https://www.sciencedirect.com/science/article/pii/S0168827821003093?via%3Dihub
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
application/pdf
dc.source.none.fl_str_mv reponame:idUS. Depósito de Investigación de la Universidad de Sevilla
instname:Universidad de Sevilla (US)
instname_str Universidad de Sevilla (US)
reponame_str idUS. Depósito de Investigación de la Universidad de Sevilla
collection idUS. Depósito de Investigación de la Universidad de Sevilla
repository.name.fl_str_mv
repository.mail.fl_str_mv
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