Diagnostic accuracy and reliability of ultrasonography for the detection of fatty liver: A meta-analysis
Open accessAbstract
Ultrasonography is a widely accessible imaging technique for the detection of fatty liver, but the reported accuracy and reliability have been inconsistent across studies. We aimed to perform a systematic review and meta-analysis of the diagnostic accuracy and reliability of ultrasonography for the detection of fatty liver. We used MEDLINE and Embase from October 1967 to March 2010. Studies that provided cross-tabulations of ultrasonography versus histology or standard imaging techniques, or that provided reliability data for ultrasonography, were included. Study variables were independently abstracted by three reviewers and double checked by one reviewer. Forty-nine (4720 participants) studies were included for the meta-analysis of diagnostic accuracy. The overall sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of ultrasound for the detection of moderate-severe fatty liver, compared to histology (gold standard), were 84.8% (95% confidence interval: 79.5-88.9), 93.6% (87.2-97.0), 13.3 (6.4-27.6), and 0.16 (0.12-0.22), respectively. The area under the summary receiving operating characteristics curve was 0.93 (0.91-0.95). Reliability of ultrasound for the detection of fatty liver showed kappa statistics ranging from 0.54 to 0.92 for intrarater reliability and from 0.44 to 1.00 for interrater reliability. Sensitivity and specificity of ultrasound was similar to that of other imaging techniques (i.e., computed tomography or magnetic resonance imaging). Statistical heterogeneity was present even after stratification for multiple clinically relevant characteristics. Conclusion: Ultrasonography allows for reliable and accurate detection of moderate-severe fatty liver, compared to histology. Because of its low cost, safety, and accessibility, ultrasound is likely the imaging technique of choice for screening for fatty liver in clinical and population settings. (HEPATOLOGY 2011; 54:1082–1090)
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Most recently published articles that have assessed inter-rater reliability have used Cohen's Kappa exclusively [19-26].
“Most recently published articles that have assessed inter-rater reliability have used Cohen’s Kappa exclusively [19-26]”
From A comparison of cohen's Kappa and gwet's AC1 when calculating inter-rater reliability coefficients: A study conducted with personality disorder samples (2013) · cites this paper as [20]
The Results section, under “Systematic Review of the Reliability of Ultrasonography” (page unavailable), reports that 17 of 22 ultrasound-reliability studies used kappa statistics, including 14 reporting interrater kappa values. This supports kappa being common, but the passage does not identify the statistic specifically as Cohen’s kappa, establish that those studies used it exclusively, or limit the finding to recently published articles. (LLM, conf=0.85)
Experimental — accuracy not yet measuredFew researchers have used AC1 as a statistical tool, or are even aware of it, especially in the medical field.
“few researchers have used AC1 as a statistical tool, or are even aware of it, especially in the medical field.”
From A comparison of cohen's Kappa and gwet's AC1 when calculating inter-rater reliability coefficients: A study conducted with personality disorder samples (2013) · cites this paper as [20]
The Results section on ultrasonography reliability reports kappa statistics and other agreement measures, but does not discuss AC1. A search of our full-text copy for AC1 and for its use or awareness among medical researchers found no passage addressing the claim; no page number was available in the indexed copy. (LLM, conf=0.76)
Experimental — accuracy not yet measured
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Nonalcoholic fatty liver disease – current status and future directions
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- Authors
- Hernaez, R., Lazo, M., Bonekamp, S., Kamel, I., Brancati, F. L., Guallar, E., & Clark, J. M.
- Affiliations
- Johns Hopkins University (US)
- Venue
- Hepatology
- Published
- 2011-09-02
- Volume
- 54
- Issue
- 3
- Pages
- 1082-1090
- ISSN
- 0270-9139 (ISSN-L)
- PMC
- PMC4197002
- OpenAlex
- W2164252555
- Cited by
- 1,585
- References
- 74
- Citations by year
- 2026: 114 · 2025: 126 · 2024: 133 · 2023: 176 · 2022: 170 · 2021: 188 · 2020: 132 · 2019: 109 · 2018: 97 · 2017: 79 · 2016: 67 · 2015: 68 · 2014: 56 · 2013: 38 · 2012: 22
- FWCI
- 4.36
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Hepatology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- American Diabetes Association
- National Institutes of Health (5p60dk079637-02)
- National Institute of Diabetes and Digestive and Kidney Diseases (P60 DK-079637, K24DK062222, R01DK083393)
- Topics
- Health Sciences › Medicine › Epidemiology › Liver Disease Diagnosis and Treatment
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Ultrasound in Clinical Applications
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Ultrasound Imaging and Elastography
- Keywords
- hepatic steatosis, ultrasonography, diagnostic accuracy, reliability statistics, sensitivity and specificity, histology comparison, non-invasive diagnosis, liver imaging
- MeSH terms
- Fatty Liver, Humans, Sensitivity and Specificity, Ultrasonography, Reproducibility of Results
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