Performance of common imaging techniques vs serum biomarkers in assessing fibrosis in patients with chronic hepatitis B: A systematic review and meta-analysis

Abstract

BACKGROUND Noninvasive biomarkers have been developed to predict hepatitis B virus (HBV) related fibrosis owing to the significant limitations of liver biopsy. Both serum biomarkers and imaging techniques have shown promising results and may improve the evaluation of liver fibrosis. However, most of the previous studies focused on the diagnostic effects of various imaging techniques on fibrosis in all chronic liver diseases. AIM To compare the performance of common imaging methods and serum biomarkers for prediction of significant fibrosis caused only by HBV infection. METHODS A systematic review was conducted on the records available in PubMed, EMBASE, and the Cochrane Library electronic databases until December 2018. We systematically assessed the effectiveness of two serum biomarkers and three imagine techniques in predicting significant fibrosis solely caused by HBV infection. The serum biomarkers included aspartate aminotransferase-to-platelet ratio index (APRI) and fibrosis index based on the 4 factors (FIB-4). The three imaging techniques included acoustic radiation force impulse (ARFI), FibroScan, and magnetic resonance elastography (MRE). Three parameters, the area under the summary receiver operating characteristic curve (AUSROC), the summary diagnostic odds ratio, and the summary sensitivity and specificity, were used to examine the accuracy of all tests for liver fibrosis. RESULTS Out of 2831 articles evaluated for eligibility, 204 satisfied the predetermined inclusion criteria for this current meta-analysis. Eventually, our final data contained 81 studies. The AUSROCs of serum biomarkers of APRI and FIB-4 were both 0.75. For imaging techniques (ARFI, FibroScan, and MRE), the areas were 0.89, 0.83, and 0.97, respectively. The heterogeneities of ARFI and FibroScan were statistically significant ( I 2 > 50%). The publication bias was not observed in any of the serum biomarkers or imaging methods. CONCLUSION These five methods have attained an acceptable level of diagnostic accuracy. Imaging techniques, MRE in particular, demonstrate significant advantages in accurately predicting HBV-related significant fibrosis, while serum biomarkers are admissible methods.

Assessment of liver fibrosis with liver and spleen magnetic resonance elastography, serum markers in chronic liver disease

“…The AUC values of FIB-4 were significantly higher than those of APRI in grading F2-4, F3-4, and F4, which was consistent with previous studies (17,48,49). Nevertheless, a recent meta-analysis found no significant differences between FIB-4 and APRI in diagnosing significant fibrosis (50). With the assessment of FIB-4 involving age and ALT, age was reported to be associated with cirrhosis.…”

Assessment of liver fibrosis with liver and spleen stiffness measured by sound touch elastography, serum fibrosis markers in patients with chronic hepatitis B

“…25,37,38 During the last two decades APRI, FIB-4 index and the King's score have been widely used for the evaluation of liver fibrosis due to the availability of the laboratory parameters included. 39,40 We demonstrated in the current study that the correlation between these three serum biomarker models and histological stages of fibrosis was limited (correlation coefficient of less than 0.5). Besides, their AUROC for assessing ≥S2, ≥ S3 and S4 fibrosis were all lower than that of LS and SS.…”

Retrospective Evaluation of Non-Invasive Assessment Based on Routine Laboratory Markers for Assessing Advanced Liver Fibrosis in Chronic Hepatitis B Patients

“…The stiffness of the liver may be measured using elastography methods such as FibroScan. 32 FibroScan is an effective diagnostic tool. However, the liver’s metabolic activity has a substantial impact on the stiffness of the liver.…”