Diagnostic accuracy of acoustic radiation force impulse elastography for the staging of hepatic fibrosis in non-alcoholic fatty liver disease: a systematic review and meta-analysis

Selvaraj, Emmanuel; Zamarfand, Hadi; Mózes, Ferenc; Jayaswal, Arjun; Levick, Christina; Palaniyappan, Naaventhan; Liu, Changhai; Aithal, Guruprasad P.; Gómez, Manuel Romero; Neubauer, Stefan; Harrison, Stephen A.; Anstee, Quentin M.; Boussy, Patrick; Pavlides, Michael

doi:10.1016/s0168-8278(20)31305-2

Cited by 29 publications

(44 citation statements)

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“…On the other hand, MRE, a novel magnetic resonance‐based technique, can be used as a non‐invasive diagnostic tool with high repeatability in the staging of liver fibrosis 22 . More recently, Xiao et al ., 15 Selvaraj et al 28 . and Mozes et al 29 .…”

Section: What Is Already Known On This Topicmentioning

confidence: 99%

Liver stiffness measurement as a quantitative method for liver fibrosis in children with non‐alcoholic fatty liver disease: A meta‐analysis

Dong

Chen

Lyu

et al. 2021

J Paediatrics Child Health

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Aim This study assessed the diagnostic performance of liver stiffness measurement (LSM) in detecting liver fibrosis in paediatric patients with non‐alcoholic fatty liver disease (NAFLD) through meta‐analysis. Methods Online database searches of PubMed, EMBASE, the Cochrane Library and the Web of Science were conducted for studies that evaluated the performance of LSM for diagnosing liver fibrosis in paediatric patients with NAFLD until 1 January 2021. The Quality Assessment of Diagnostic Accuracy Studies‐2 (QUADAS‐2) tool was used to assess the quality of the included studies. Three measures were used to assess the performance of LSM for detecting liver fibrosis in paediatric patients with NAFLD, including the summary sensitivities and specificities, the summary area under the receiver operating characteristic curves and the summary diagnostic odds ratios. Results Our final data included seven studies with a total of 436 paediatric patients with NAFLD for meta‐analysis. The overall prevalence of mild fibrosis, significant fibrosis, advanced fibrosis and cirrhosis was 66.3, 31.5, 14.9 and 1.2%, respectively. The summary sensitivity, specificity and area under the receiver operating characteristic values of LSM were 80, 92 and 0.94 for the prediction of mild fibrosis; 91, 97 and 0.98 for the prediction of significant fibrosis; and 89, 93 and 0.96 for the prediction of advanced fibrosis, respectively. Conclusion Liver stiffness measurement exhibited good diagnostic performance in predicting liver fibrosis and can be used as a non‐invasive tool in the management of paediatric patients with non‐alcoholic fatty liver disease.

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Section: What Is Already Known On This Topicmentioning

confidence: 99%

Liver stiffness measurement as a quantitative method for liver fibrosis in children with non‐alcoholic fatty liver disease: A meta‐analysis

Dong

Chen

Lyu

et al. 2021

J Paediatrics Child Health

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“…Despite a large body of evidence in favor of NITs as a substitute for biopsy, [4,[18][19][20] this survey shows that most SPs still consider the positive predictive value of current tests insufficient. In fact, in a hypothetical scenario where results of NITs concur in favor of the presence of advanced fibrosis, three quarters of SPs would still perform a liver biopsy, while only a minority would do so in case of a clear indication of minimal or no fibrosis.…”

Section: Discussionmentioning

confidence: 86%

An international survey on patterns of practice in NAFLD and expectations for therapies—The POP‐NEXT project

et al. 2022

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Background and Aims Differences between countries in NAFLD patient care pathways and management need to be understood prior to defining supranational guidelines. Approach and Results We conducted an anonymous survey in France, Germany, Hong Kong, Italy, Romania, Spain, the United Kingdom, and the United States among physicians providing specialist care for patients with NAFLD. Modalities of patient referral, patterns of practice (diagnosis, staging, monitoring, and indications for liver biopsy), therapeutic management, and expectations for future NASH pharmacotherapies were assessed, with 664 physicians completing the survey. Referral to surveyed physicians (SPs) mostly came from primary care. Prior to referral, NAFLD was rarely diagnosed, and noninvasive tests were not performed. Screening for comorbidities by SPs was incomplete and cardiovascular risk not calculated. Elastometry in combination with a serum biomarker was the most common first‐line method for fibrosis staging. Liver biopsy, when performed, was often delayed by at least 1 year after diagnosis. It was, however, recommended even if noninvasive methods indicated advanced fibrosis. Frequent, biannual monitoring was conducted, including HCC surveillance in Stage 3 fibrosis. SPs rarely implemented and followed dietary and lifestyle changes themselves, and local availability of such programs was highly heterogenous. SPs favored pharmacotherapy based on mechanism of action adapted to the stage of the disease, including for early stages such as steatohepatitis with mild fibrosis. Conclusions This international survey revealed major deficiencies and delays in referral pathways, suboptimal screening for comorbidities or managing of lifestyle modifications by SPs, and limited local availability for nonpharmacological interventions. Monitoring practices are not aligned with current guidelines.

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“…In TE, the pooled sensitivity and specificity were 0.76–0.82 and 0.65–0.91, respectively, with an AUROC of 0.81–0.91 for the staging of significant fibrosis (F ≥ 2), 0.75–1.00 and 0.74–0.91, respectively, with an AUROC of 0.84–0.91 for the staging of severe fibrosis (F ≥ 3), and 0.69–0.92 and 0.81–0.88, respectively, with an AUROC of 0.84–0.95 for the staging of cirrhosis (F4). 109 , 124 , 125 , 128 – 132 In SWE, the pooled sensitivity and specificity were 0.71–0.88 and 0.67–0.83, respectively, with an AUROC of 0.79–0.92 for the staging of significant fibrosis (F ≥ 2), 0.72–0.95 and 0.72–0.87, respectively, with an AUROC of 0.72–0.95 for the staging of severe fibrosis (F ≥ 3), and 0.75–0.89 and 0.84–0.93, respectively, with an AUROC of 0.88–0.94 for the staging of cirrhosis (F4). 123 , 124 , 132 – 137 Therefore, the diagnostic ability of TE and SWE for staging liver fibrosis cannot be as high as that of MRE.…”

Section: Clinical Needs For Diffuse Liver Diseasesmentioning

confidence: 99%

“… 109 , 124 , 125 , 128 – 132 In SWE, the pooled sensitivity and specificity were 0.71–0.88 and 0.67–0.83, respectively, with an AUROC of 0.79–0.92 for the staging of significant fibrosis (F ≥ 2), 0.72–0.95 and 0.72–0.87, respectively, with an AUROC of 0.72–0.95 for the staging of severe fibrosis (F ≥ 3), and 0.75–0.89 and 0.84–0.93, respectively, with an AUROC of 0.88–0.94 for the staging of cirrhosis (F4). 123 , 124 , 132 – 137 Therefore, the diagnostic ability of TE and SWE for staging liver fibrosis cannot be as high as that of MRE.…”

Section: Clinical Needs For Diffuse Liver Diseasesmentioning

confidence: 99%

Clinical Significance of Liver MR Imaging

Ichikawa

Goshima

2023

magn reson med sci

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MRI is widely used in clinical practice for detecting liver diseases. Since the introduction of gadoxetic acid, MRI has become the most effective modality for the detection and characterization of focal liver lesions. According to previous meta-analyses, the area under the receiver operating characteristic curve (AUROC) was 0.97–0.99 for the diagnosis of small hepatocellular carcinoma (≥ 2 cm) by gadoxetic-acid-enhanced MRI. Moreover, the AUROC for the diagnosis of colorectal liver metastases was significantly high (0.98). Despite gadoxetic acid’s drawbacks, its clinical utility outweighs them, making it the contrast agent of choice in routine liver MRIs. Moreover, clinically, liver MRI has become more prevalent for a quantitative assessment. Liver fibrosis can be evaluated using MR elastography; whereas, hepatic steatosis and iron overload can be evaluated using proton density fat fraction, with high accuracy and reproducibility. This article reviewed the usefulness of liver MRI, which can be a comprehensive imaging modality in clinical practice.

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Diagnostic accuracy of acoustic radiation force impulse elastography for the staging of hepatic fibrosis in non-alcoholic fatty liver disease: a systematic review and meta-analysis

Cited by 29 publications

References 0 publications

Liver stiffness measurement as a quantitative method for liver fibrosis in children with non‐alcoholic fatty liver disease: A meta‐analysis

Liver stiffness measurement as a quantitative method for liver fibrosis in children with non‐alcoholic fatty liver disease: A meta‐analysis

An international survey on patterns of practice in NAFLD and expectations for therapies—The POP‐NEXT project

Clinical Significance of Liver MR Imaging

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