Diagnostic accuracy of elastography and magnetic resonance imaging in patients with NAFLD: a systematic review and meta-analysis
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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.
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Several substantial comparative studies have shown that MRE provides at least equal quality in fibrosis staging as ultrasound-based elastography techniques.
“Several substantial comparative studies have shown that MRE provides at least equal quality in fi brosis staging as ultrasound-based elastography techniques.”
From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [157]
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- Authors
- Selvaraj, E. A., Mózes, F. E., Jayaswal, A. N. A., Zafarmand, M. H., Vali, Y., Lee, J. A., Levick, C. K., Young, L. A. J., Palaniyappan, N., Liu, C.-H., Aithal, G. P., Romero-Gómez, M., Brosnan, M. J., Tuthill, T. A., Anstee, Q. M., Neubauer, S., Harrison, S. A., Bossuyt, P. M., Pavlides, M., Anstee, Q., Daly, A., Johnson, K., Govaere, O., Cockell, S., Tiniakos, D., Bedossa, P., Oakley, F., Cordell, H., Day, C., Wonders, K., Bossuyt, P., Zafarmand, H., Vali, Y., Lee, J., Ratziu, V., Clement, K., Pais, R., Schuppan, D., Schattenberg, J., Vidal-Puig, T., Vacca, M., Rodrigues-Cuenca, S., Allison, M., Kamzolas, I., Petsalaki, E., Oresic, M., Hyötyläinen, T., McGlinchey, A., Mato, J. M., Millet, O., Dufour, J.-F., Berzigotti, A., Pavlides, M., Harrison, S., Neubauer, S., Cobbold, J., Mozes, F., Akhtar, S., Banerjee, R., Kelly, M., Shumbayawonda, E., Dennis, A., Erpicum, C., Romero-Gómez, M., Gómez-González, E., Ampuero, J., Castell, J., Gallego-Durán, R., Fernández, I., Montero-Vallejo, R., Karsdal, M., Erhardtsen, E., Rasmussen, D., Leeming, D. J., Fisker, M. J., Sinisi, A., Musa, K., Betsou, F., Sandt, E., Tonini, M., Bugianesi, E., Rosso, C., Armandi, A., Marra, F., Gastaldelli, A., Svegliati, G., Boursier, J., Francque, S., Vonghia, L., Ekstedt, M., Kechagias, S., Yki-Jarvinen, H., Luukkonen, P., van Mil, S., Papatheodoridis, G., Cortez-Pinto, H., Valenti, L., Petta, S., Miele, L., Geier, A., Trautwein, C., Aithal, G., Hockings, P., Newsome, P., Wenn, D., Pereira Rodrigues, C. M., Chaumat, P., Hanf, R., Trylesinski, A., Ortiz, P., Duffin, K., Brosnan, J., Tuthill, T., McLeod, E., Ertle, J., Younes, R., Ostroff, R., Alexander, L., Kjær, M. S., Mikkelsen, L. F., Balp, M.-M., Brass, C., Jennings, L., Martic, M., Loeffler, J., Hanauer, G., Shankar, S., Fournier, C., Pepin, K., Ehman, R., Myers, J., Ho, G., Torstenson, R., Myers, R., & Doward, L.
- Affiliations
- University of Oxford (GB)
- Nottingham University Hospitals NHS Trust (GB)
- Pfizer (United States) (US)
- Amsterdam University Medical Centers (NL)
- Instituto de Biomedicina de Sevilla (ES)
- ORCID
- Selvaraj, Emmanuel Anandraj
- Jayaswal, Arjun Narayan Ajmer
- Lee, Jenny A.
- Levick, Christina Kim
- Young, Liam Arnold Joseph
- Palaniyappan, Naaventhan
- Liu, Chang-Hai
- Aithal, Guruprasad Padur
- Tuthill, Theresa A.
- Anstee, Quentin M.
- Daly, Ann
- Johnson, Katherine
- Govaere, Olivier
- Cockell, Simon
- Tiniakos, Dina
- Oakley, Fiona
- Cordell, Heather
- Day, Chris
- Wonders, Kristy
- Ratziu, Vlad
- Pais, Raluca
- Schuppan, Detlef
- Schattenberg, Jörn
- Kamzolas, Ioannis
- Petsalaki, Evangelia
- Hyötyläinen, Tuulia
- Dufour, Jean-François
- Berzigotti, Annalisa
- Cobbold, Jeremy
- Banerjee, Rajarshi
- Kelly, Matt
- Shumbayawonda, Elizabeth
- Dennis, Andrea
- Gómez-González, Emilio
- Ampuero, Javier
- Karsdal, Morten
- Rasmussen, Daniel
- Betsou, Fay
- Bugianesi, Elisabetta
- Rosso, Chiara
- Armandi, Angelo
- Marra, Fabio
- Gastaldelli, Amalia
- Boursier, Jérôme
- Francque, Sven
- Vonghia, Luisa
- Ekstedt, Mattias
- Kechagias, Stergios
- Luukkonen, Panu
- Papatheodoridis, George
- Valenti, Luca
- Petta, Salvatore
- Miele, Luca
- Geier, Andreas
- Trautwein, Christian
- Hockings, Paul
- Newsome, Philip
- Ortiz, Pablo
- Duffin, Kevin
- Ertle, Judith
- Younes, Ramy
- Ostroff, Rachel
- Alexander, Leigh
- Kjær, Mette Skalshøi
- Mikkelsen, Lars Friis
- Balp, Maria-Magdalena
- Jennings, Lori
- Loeffler, Juergen
- Shankar, Sudha
- Fournier, Céline
- Pepin, Kay
- Ehman, Richard
- Ho, Gideon
- Doward, Lynda
- Venue
- Journal of Hepatology
- Publisher
- Elsevier BV
- Published
- 2021-10
- Volume
- 75
- Issue
- 4
- Pages
- 770-785
- ISSN
- 0168-8278 (ISSN-L)
- OpenAlex
- W3161701468
- Cited by
- 376
- References
- 107
- Citations by year
- 2026: 67 · 2025: 84 · 2024: 77 · 2023: 81 · 2022: 52 · 2021: 14
- FWCI
- 8.58
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Journal of Hepatology (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Deposito de Investigacion Universidad de Sevilla (University of Seville) (publishedVersion, cc-by-nc-nd)
- Pure Amsterdam UMC (publishedVersion, cc-by)
- University of Birmingham Research Portal (University of Birmingham) (publishedVersion, cc-by-nc-nd)
- Repository@Nottingham (University of Nottingham) (acceptedVersion, other-oa)
- Florence Research (University of Florence) (submittedVersion, cc-by-nc-nd)
- Repository@Nottingham (University of Nottingham) (submittedVersion, cc-by-nc-nd)
- Lirias (KU Leuven) (submittedVersion, cc-by-nc-nd)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- HAL (submittedVersion)
- Archivio Istituzionale della Ricerca (Universita Degli Studi Di Milano) (submittedVersion, other-oa)
- DIGITAL.CSIC (Spanish National Research Council (CSIC)) (submittedVersion, cc-by-nc-nd)
- Utrecht University Repository (Utrecht University) (submittedVersion, other-oa)
- Nova Science Publishers (Nova Science Publishers, Inc.) (submittedVersion, other-oa)
- PubliCatt (Università Cattolica del Sacro Cuore) (submittedVersion, cc-by-nc-nd)
- CINECA IRIS Institutional Research Information System (University of Bari Aldo Moro) (submittedVersion, cc-by-nc-nd)
- Newcastle University ePrints (Newcastle Univesity) (cc-by-nc-nd)
- Funders
- European Federation of Pharmaceutical Industries and Associations
- Innovative Medicines Initiative (777377)
- Topics
- Health Sciences › Medicine › Epidemiology › Liver Disease Diagnosis and Treatment
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Ultrasound Imaging and Elastography
- Health Sciences › Medicine › Hepatology › Liver Disease and Transplantation
- Keywords
- non-alcoholic fatty liver disease, liver fibrosis, nonalcoholic steatohepatitis, vibration-controlled transient elastography, point shear wave elastography, two-dimensional shear wave elastography, magnetic resonance elastography, magnetic resonance imaging, noninvasive fibrosis assessment, liver cirrhosis, diagnostic accuracy
- MeSH terms
- Adult, Humans, Magnetic Resonance Imaging, ROC Curve, Area Under Curve, Elasticity Imaging Techniques, Non-alcoholic Fatty Liver Disease
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