Diagnostic Performance of Magnetic Resonance Elastography in Staging Liver Fibrosis: A Systematic Review and Meta-analysis of Individual Participant Data

Abstract

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.

Elastography in Chronic Liver Disease: Modalities, Techniques, Limitations, and Future Directions

“…The high accuracy is probably related to the large volume of parenchymal sampling, with the potential to assess the stiffness of nearly the entire liver parenchyma. The technique also has high technical success, providing reliable examinations even in obese patients and in those with hepatic steatosis (59,63,64). After the required hardware has been set up, MR elastography may be added to any routine MR imaging protocol with only a few minutes of additional imaging time.…”

“…MR elastography is currently regarded as the most accurate noninvasive method for detection and staging of liver fibrosis (57)(58)(59). Calculations of liver stiffness with MR elastography are highly reproducible and show excellent interobserver agreement (60)(61)(62).…”

The shear effort of measurement of portal hypertension

“…Using a cell protection-based high-throughput screening assay, 4 our laboratory also recently reported anti-HCV activity of chlorcyclizine and related compounds. 5 We found that the entry inhibition of chlorcyclizine is dependent on the cholesterol content of the host cell and virion. Other molecules reported to inhibit the entry of HCVcc, but not HCVpp, include rabeprazole, 6 ezetimibe, 7 and human apolipoprotein E peptides.…”

“…Cross-sectional radiologic examinations such as computed tomography and magnetic resonance have been used to measure liver fibrosis and to identify specific complications of portal hypertension. 4,5 Transient elastography (TE) has demonstrated reliability in noninvasively staging hepatic fibrosis and has been widely accepted for this indication. TE has also been used to assess for the presence of portal hypertension through LS or SS measurements, although performance characteristics have not been sufficient for widespread application.…”

APASL consensus statements and recommendations for hepatitis C prevention, epidemiology, and laboratory testing

“…Although liver biopsy remains the gold standard to assess liver fibrosis, alternative noninvasive approaches for liver fibrosis have assumed great importance. Approaches include the following [192][193][194]:…”