Background & Aims
Magnetic resonance elastography (MRE) is a non-invasive tool for staging liver fibrosis. We conducted a meta-analysis of individual participant data collected from published studies to assess the diagnostic accuracy of MRE and for staging liver fibrosis in patients with chronic liver diseases (CLD).
Methods
Through a systematic literature search of multiple databases (2003–2013), we identified studies on diagnostic performance of MRE for staging liver fibrosis in patients with CLD with native anatomy, using liver biopsy as the standard. We contacted study authors to collect data on each participant’s age, sex, body mass index (BMI), liver stiffness (measured by MRE), fibrosis stage, staging system used, degree of inflammation, etiology of CLD, and interval between MRE and biopsy. Through pooled analysis, we calculated the cluster-adjusted area under receiver-operating curve (AUROC), sensitivity, and specificity of MRE for any fibrosis (≥stage 1), significant fibrosis (≥stage 2), advanced fibrosis (≥stage 3), and cirrhosis (stage 4)
Results
We analyzed data from 12 retrospective studies, comprising 697 patients (mean age, 55±13 years; 59.4% male; mean BMI, 26.9±6.7 kg/m2; 92.1% with <1 year interval between MRE and biopsy; hepatitis C in 47.1%). Participants had fibrosis stages 0, 1, 2, 3, or 4 (19.5%, 19.4%, 15.5%, 15.9% and 29.7%, respectively). Mean AUROC values (and 95% confidence intervals) for diagnosis of any (≥stage 1), significant (≥stage 2), or advanced fibrosis (≥stage 3), and cirrhosis, were 0.84 (0.76–0.92), 0.88 (0.84–0.91), 0.93 (0.90–0.95), and 0.92 (0.90–0.94), respectively. Similar diagnostic performance was observed in stratified analysis based on sex, obesity, and etiology of CLD. The overall rate of failure of MRE was 4.3%.
Conclusion
Based on pooled analysis of data from individual participants, MRE has high accuracy for diagnosis of significant or advanced fibrosis and cirrhosis, independent of BMI and etiology of CLD. Prospective studies are warranted to better understand the diagnostic performance of MRE.