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Magnetic resonance elastography and acoustic radiation force impulse for staging hepatic fibrosis: a meta-analysis

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Abstract

Purpose

Elastography is a non-invasive method to quantify fibrosis based on tissue mechanical properties. We performed a meta-analysis to assess the diagnostic accuracy of two such techniques: Acoustic Radiation Force Impulse Imaging (ARFI) or Magnetic Resonance Elastography (MRE) for staging hepatic fibrosis.

Materials and Methods

Literature databases were searched until June 2013. Inclusion criteria were evaluation of MRE or ARFI, liver biopsy, and reported sensitivity and specificity. A random effects model was used to combine sensitivity and specificity, from which positive (LR+) and negative (LR−) likelihood ratios, diagnostic odds ratios, and area under receiver operating characteristics curve (AUROC) were derived. Differences between MRE and ARFI were compared with t tests (P < 0.05 considered significant).

Results

Eleven MRE studies including 982 patients and fifteen ARFI studies including 2,128 patients were selected. AUROC for MRE staging fibrosis were 0.94, 0.97, 0.96, and 0.97 for F1–F4, respectively, whereas AUROC for ARFI staging were 0.82, 0.85, 0.94, and 0.94 for F1–F4, respectively. Significance was found in AUROC between MRE and ARFI for the diagnosis of stage 1 and 2 fibrosis.

Conclusion

MRE is more accurate than ARFI with a higher combination of sensitivity, specificity, LR, and AUROC particularly in diagnosing early stages of hepatic fibrosis.

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Abbreviations

APRI:

Aspartate aminotransferase-to-platelet ratio index

ARFI:

Acoustic radiation force impulse

AUROC:

Area under the receiver operating characteristic curve

ALD:

Alcoholic liver disease

AIH:

Autoimmune hepatitis

BMI:

Body mass index

CLD:

Chronic liver disease

CHC:

Chronic hepatitis C

CHB:

Chronic hepatitis B

CI:

Confidence interval

CT:

Computed tomography

DOR:

Diagnostic odds ratio

ECM:

Extracellular matrix

FP:

False positive

FN:

False negative

HIV:

Human immunodeficiency virus

HCV:

Hepatitis C virus

kPa:

kilopascal

LR+:

Positive likelihood ratio

LR−:

Negative likelihood ratio

MRE:

Magnetic resonance elastography

NPV:

Negative predictive value

NAFLD:

Non-alcoholic fatty liver disease

NASH:

Non-alcoholic steatohepatitis

PPV:

Positive predictive value

PBC:

Primary biliary cirrhosis

PSC:

Primary sclerosing cholangitis

ROC:

Receiver operating characteristics

Se:

Sensitivity

Sp:

Specificity

TE:

Transient elastography

TP:

True positive

TN:

True negative

US:

Ultrasound

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Authors and Affiliations

  1. Department of Radiology, Northwestern University Feinberg School of Medicine, NMH/Arkes Family Pavilion Suite 800, 676 N Saint Clair, Chicago, IL, 60611, USA

    Yang Guo, Preeya Goyal, Andrew C. Larson & Frank H. Miller

  2. Chicago Medical School, Rosalind Franklin University of Medicine, Chicago, IL, USA

    Sudharshan Parthasarathy

  3. Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Robert J. McCarthy

  4. Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA

    Andrew C. Larson

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  1. Yang Guo
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  2. Sudharshan Parthasarathy
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Correspondence to Frank H. Miller.

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Guo, Y., Parthasarathy, S., Goyal, P. et al. Magnetic resonance elastography and acoustic radiation force impulse for staging hepatic fibrosis: a meta-analysis. Abdom Imaging 40, 818–834 (2015). https://doi.org/10.1007/s00261-014-0137-6

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