Abstract
Objectives
Acoustic radiation force impulse (ARFI) imaging is an ultrasound-based elastography method that is integrated into a conventional ultrasound machine. A meta-analysis based on original and abstract publications was performed to evaluate the overall performance of ARFI for the diagnosis of liver fibrosis.
Methods
Literature databases and conference abstracts were searched from 2007 up to February 2012. A random effects meta-analysis of the area under the receiver operating characteristic (ROC) curve (AUROC) and the diagnostic odds ratio (DOR) was performed as well as summary ROC curve techniques. Quality analyses were conducted to assess sources of heterogeneity.
Results
The systematic literature search revealed 36 studies, with 3,951 patients overall. The mean diagnostic accuracy of ARFI expressed as the AUROC was 0.84 (DOR, 11.54) for the diagnosis of significant fibrosis (F ≥ 2), 0.89 (DOR, 33.54) for the diagnosis of severe fibrosis (F ≥ 3) and 0.91 (DOR, 45.35) for the diagnosis of liver cirrhosis (F = 4). Subgroup analyses showed sources of heterogeneity between the different underlying liver diseases for F ≥ 3 and F = 4. The mean body mass index had a significant influence for F ≥ 2.
Conclusions
The meta-analysis revealed good diagnostic accuracy of the ARFI imaging for the staging of F ≥ 2 and F ≥ 3, and excellent diagnostic accuracy for F = 4.
Key Points
• Acoustic radiation force impulse (ARFI) imaging adds important information over conventional ultrasound.
• ARFI imaging provides good diagnostic performance for assessing significant/severe hepatic fibrosis.
• ARFI imaging shows excellent diagnostic accuracy and odds ratio for cirrhosis staging.
• Body mass index significantly influences the assessment of significant fibrosis.
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Abbreviations
- ARFI:
-
Acoustic radiation force impulse
- AUROC:
-
Area under the ROC curve
- CLD:
-
Chronic liver disease
- DOR:
-
Diagnostic odds ratio
- F:
-
Fibrosis stage
- HBV:
-
Chronic hepatitis B
- HCV:
-
Chronic hepatitis C
- IPD:
-
Individual patient data
- ROC:
-
Receiver operating characteristic curve
- SROC:
-
Summary ROC
- TE:
-
Transient elastography
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Figure S1
Forest Plots from meta-analysis of the DOR. Forest plots for F ≥ 2 (a), F ≥ 3 (b) and F = 4 (c) using the random effects model. The size of squares is shown proportional to the weight that the respective study contributes to the estimator of the overall DOR. Studies with a larger sample size get more weight than studies with a small sample size. (JPEG 273 kb)
Figure B
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Figure C
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Figure S2
Funnel Plots. Assessment of publication bias using the funnel plots of the log diagnostic odds ratio for F < 2 vs. F ≥ 2 (A), F < 3 vs. F ≥ 3 (B) and F < 4 vs. F = 4 (C) against a sample size dependent term, where root(ess) describes the root of the effective sample size [18]. The funnel plots are trimmed and filled to adjust for a possible asymmetry arising from publication bias [20]. While the funnel plot for F ≥ 2 indicates asymmetry (p = 0.0094), the funnel plots for F ≥ 3 (p = 0.1955) and F = 4 (p = 0.95) do not seem to deviate from symmetry. (JPEG 64 kb)
Figure B
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Figure C
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Figure S3
QUADAS criteria. Proportion of studies rated as yes, no or unclear for each of the QUADAS items. In the right columns it is specified for each QUADAS item if there was a significant reduction of heterogeneity for the AUROC estimates. For three QUADAS items (appropriate reference standard, partial verification bias, incorporation bias) a p-value cannot be calculated because of missing values to be needed for the estimation of the standard error of the AUROC. (JPEG 108 kb)
Table S1
Quality Assessment Using QUADAS Questionnaire (DOCX 26 kb)
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Nierhoff, J., Chávez Ortiz, A.A., Herrmann, E. et al. The efficiency of acoustic radiation force impulse imaging for the staging of liver fibrosis: a meta-analysis. Eur Radiol 23, 3040–3053 (2013). https://doi.org/10.1007/s00330-013-2927-6
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DOI: https://doi.org/10.1007/s00330-013-2927-6