Cited by 895Liver Disease Diagnosis and TreatmentLiver Disease and TransplantationUltrasound Imaging and Elastography

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Comparison of laboratory tests, ultrasound, or magnetic resonance elastography to detect fibrosis in patients with nonalcoholic fatty liver disease: a meta-analysis

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Xiao, Guangqin, Zhu, Sixian, Xiao, Xiao, Yan, Lunan, Yang, Jiayin, Wu, Gang·2017·Hepatology

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Abstract

Many noninvasive methods for diagnosing liver fibrosis (LF) have been proposed. To determine the best method for diagnosing LF in nonalcoholic fatty liver disease (NAFLD), we conducted a systemic review and meta-analysis to compare the performance of aspartate aminotransferase to platelets ratio index (APRI), fibrosis-4 index (FIB-4), BARD score, NAFLD fibrosis score (NFS), FibroScan, shear wave elastography (SWE), and magnetic resonance elastography (MRE) for diagnosing LF in NAFLD. We compared the sensitivity, specificity, positive predictive value, negative predictive value, and area under the receiver operating characteristic curve (AUROC) of these noninvasive methods for detecting significant fibrosis (SF), advanced fibrosis (AF), and cirrhosis. Heterogeneity was explored using meta-regression. Sixty-four articles with a total of 13,046 NAFLD subjects were included. The overall mean prevalence of SF, AF, and cirrhosis was 45.0%, 24.0%, and 9.4% in NAFLD patients, respectively. With an APRI threshold of 1.0 and 1.5, the sensitivities and specificities were 50.0% and 84.0% and 18.3% and 96.1%, respectively, for AF. With a FIB-4 threshold of 2.67 and 3.25, the sensitivities and specificities were 26.6% and 96.5% and 31.8% and 96.0%, respectively, for AF. The summary sensitivities and specificities of BARD score (threshold of 2), NFS (threshold of -1.455), FibroScan M (threshold of 8.7-9), SWE, and MRE for detecting AF were 0.76 and 0.61, 0.72 and 0.70, 0.87 and 0.79, 0.90 and 0.93, and 0.84 and 0.90, respectively. The summary AUROC values using APRI, FIB-4, BARD score, NFS, FibroScan M probe, XL probe, SWE, and MRE for diagnosing AF were 0.77, 0.84, 0.76, 0.84, 0.88, 0.85, 0.95, and 0.96, respectively. CONCLUSION: MRE and SWE may have the highest diagnostic accuracy for staging fibrosis in NAFLD patients. Among the four noninvasive simple indexes, NFS and FIB-4 probably offer the best diagnostic performance for detecting AF. (Hepatology 2017;66:1486-1501).

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Development of a simple noninvasive index to predict significant fibrosis in patients with HIV/HCV coinfection†‡
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“Dozens of noninvasive models composed of blood biochemical biomarkers have been proposed to detect LF, including aspartate aminotransferase to platelets ratio index (APRI)((5)) and fibrosis-4 index (FIB-4).((6)) However, APRI and FIB-4 were established based on patients with hepatitis C virus (HCV) infection or HIV/HC…”
Method
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Authors: Xiao, G., Zhu, S., Xiao, X., Yan, L., Yang, J., & Wu, G.
Affiliations: Huazhong University of Science and Technology (CN)
Tongji Hospital (CN)
Henan Medical University (CN)
Department of Liver Surgery,West China Hospital of Sichuan University,Chengdu,China
West China Hospital of Sichuan University (CN)
Corresponding author: Wu, Gang
ORCID: Xiao, Xiao
Yang, Jiayin
Wu, Gang
Venue: Hepatology
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2017-09-26
Volume: 66
Issue: 5
Pages: 1486-1501
ISSN: 0270-9139 (ISSN-L)
1527-3350
DOI: 10.1002/hep.29302
OpenAlex: W2622132351
Cited by: 895
References: 32
Citations by year: 2026: 68 · 2025: 85 · 2024: 109 · 2023: 118 · 2022: 142 · 2021: 147 · 2020: 117 · 2019: 62 · 2018: 38 · 2017: 7
FWCI: 47.96
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: onlinelibrary.wiley.com/termsAndConditions#vor (vor)
doi.wiley.com/10.1002/tdm_license_1.1 (tdm)
Locations: Hepatology (publishedVersion)
PubMed (publishedVersion)
Funders: National Natural Science Foundation of China (81600482, 81472201, 81172150)
Topics: Health Sciences › Medicine › Hepatology › Liver Disease Diagnosis and Treatment
Health Sciences › Medicine › Hepatology › Liver Disease and Transplantation
Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Ultrasound Imaging and Elastography
Keywords: non-alcoholic fatty liver disease, liver fibrosis, noninvasive fibrosis assessment, APRI, FIB-4, NAFLD fibrosis score, BARD score, FibroScan, shear wave elastography, magnetic resonance elastography, liver cirrhosis, diagnostic accuracy, sensitivity and specificity, ultrasound elastography, liver stiffness, meta-regression
MeSH terms: China, Fibrosis, Humans, Liver, Liver Cirrhosis, Ultrasonography, Prevalence, Elasticity Imaging Techniques, Non-alcoholic Fatty Liver Disease

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Comparison of laboratory tests, ultrasound, or magnetic resonance elastography to detect fibrosis in patients with nonalcoholic fatty liver disease: a meta-analysis

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