@article{3101886,
    title = "Diagnostic accuracy of elastography and magnetic resonance imaging in patients with NAFLD: A systematic review and meta-analysis",
    author = "Selvaraj, E.A. and Mózes, F.E. and Jayaswal, A.N.A. and Zafarmand, M.H. and Vali, Y. and Lee, J.A. and Levick, C.K. and Young, L.A.J. and Palaniyappan, N. and Liu, C.-H. and Aithal, G.P. and Romero-Gómez, M. and Brosnan, M.J. and Tuthill, T.A. and Anstee, Q.M. and Neubauer, S. and Harrison, S.A. and Bossuyt, P.M. and Pavlides, M. and Daly, A. and Johnson, K. and Govaere, O. and Cockell, S. and Tiniakos, D. and Bedossa, P. and Oakley, F. and Cordell, H. and Day, C. and Wonders, K. and Bossuyt, P. and Zafarmand, H. and Lee, J. and Ratziu, V. and Clement, K. and Pais, R. and Schuppan, D. and Schattenberg, J. and Vidal-Puig, T. and Vacca, M. and Rodrigues-Cuenca, S. and Allison, M. and Kamzolas, I. and Petsalaki, E. and Oresic, M. and Hyötyläinen, T. and McGlinchey, A. and Mato, J.M. and Millet, O. and Dufour, J.-F. and Berzigotti, A. and Harrison, S. and Cobbold, J. and Mozes, F. and Akhtar, S. and Banerjee, R. and Kelly, M. and Shumbayawonda, E. and Dennis, A. and Erpicum, C. and Gómez-González, E. and Ampuero, J. and Castell, J. and Gallego-Durán, R. and Fernández, I. and Montero-Vallejo, R. and Karsdal, M. and Erhardtsen, E. and Rasmussen, D. and Leeming, D.J. and Fisker, M.J. and Sinisi, A. and Musa, K. and Betsou, F. and Sandt, E. and Tonini, M. and Bugianesi, E. and Rosso, C. and Armandi, A. and Marra, F. and Gastaldelli, A. and Svegliati, G. and Boursier, J. and Francque, S. and Vonghia, L. and Ekstedt, M. and Kechagias, S. and Yki-Jarvinen, H. and Luukkonen, P. and van Mil, S. and Papatheodoridis, G. and Cortez-Pinto, H. and Valenti, L. and Petta, S. and Miele, L. and Geier, A. and Trautwein, C. and Aithal, G. and Hockings, P. and Newsome, P. and Wenn, D. and Pereira Rodrigues, C.M. and Chaumat, P. and Hanf, R. and Trylesinski, A. and Ortiz, P. and Duffin, K. and Brosnan, J. and Tuthill, T. and McLeod, E. and Ertle, J. and Younes, R. and Ostroff, R. and Alexander, L. and Kjær, M.S. and Mikkelsen, L.F. and Balp, M.-M. and Brass, C. and Jennings, L. and Martic, M. and Loeffler, J. and Hanauer, G. and Shankar, S. and Fournier, C. and Pepin, K. and Ehman, R. and Myers, J. and Ho, G. and Torstenson, R. and Myers, R. and Doward, L. and LITMUS Investigators",
    journal = "WORLD JOURNAL OF HEPATOLOGY",
    year = "2021",
    volume = "75",
    number = "4",
    pages = "770-785",
    publisher = "Elsevier B.V.",
    doi = "10.1016/j.jhep.2021.04.044",
    keywords = "adult;  aged;  area under the curve;  Article;  cohort analysis;  diagnostic accuracy;  diagnostic test accuracy study;  false positive result;  female;  human;  liver biopsy;  liver cirrhosis;  liver fibrosis;  magnetic resonance elastography;  male;  meta analysis;  non invasive procedure;  nonalcoholic fatty liver;  nonalcoholic steatohepatitis;  nuclear magnetic resonance imaging;  predictive value;  prevalence;  Quality Assessment of Diagnostic Accuracy Studies;  radiodiagnosis;  receiver operating characteristic;  sensitivity and specificity;  shear wave elastography;  standard;  systematic review;  diagnostic imaging;  elastography;  nonalcoholic fatty liver;  nuclear magnetic resonance imaging;  procedures, Adult;  Area Under Curve;  Elasticity Imaging Techniques;  Humans;  Magnetic Resonance Imaging;  Non-alcoholic Fatty Liver Disease;  ROC Curve",
    abstract = "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 pre-specified 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. © 2021 The Author(s)"
}