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Liver fibrosis staging with diffusion-weighted imaging: a systematic review and meta-analysis

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Abstract

Purpose

A meta-analysis was performed to assess the diagnostic performance of diffusion-weighted imaging (DWI) in liver fibrosis (LF) staging.

Methods

We conducted a comprehensive literature search to identify relevant articles. Diagnostic data were extracted for each METAVIR fibrosis stage (F0–F4). A bivariate binomial model was used to combine sensitivities and specificities. Summary receiver operating characteristics (SROC) curves were performed and areas under SROC curve (AUC) were calculated to indicate diagnostic accuracies. Subgroup analyses were performed between different study characteristics.

Results

Twelve studies met the inclusion criteria for LF ≥F1, 16 for ≥F2, 18 for ≥F3, and 12 for F4. AUCs of DWI were 0.8554, 0.8770, 0.8836, and 0.8596 for ≥F1, ≥F2, ≥F3, and F4, respectively. Subgroup analyses showed that for LF ≥F2 and ≥F3, maximal b values (b max) ≥ 800 s/mm2 performed significantly better than b max < 800 s/mm2. The diagnostic accuracies of 3.0 T and intravoxel incoherent motion (IVIM)-DWI were significantly higher than those of 1.5 T and conventional DWI for diagnosing liver cirrhosis (F4).

Conclusions

DWI is a reliable noninvasive technique with good diagnostic accuracy for LF staging. Using b max ≥ 800 s/mm2, high-field strength (3.0 T) and IVIM-DWI can optimize the diagnostic performance of DWI.

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Abbreviations

ADC:

Apparent diffusion coefficient

AUC:

Area under SROC curve

b max :

Maximal b value

CI:

Confidence interval

CLD:

Chronic liver disease

DWI:

Diffusion-weighted imaging

ECM:

Extracellular matrix

FN:

False-negative

FP:

False-positive

HCC:

Hepatocellular carcinoma

IVIM:

Intravoxel incoherent motion

MR:

Magnetic resonance

MRE:

Magnetic resonance elastography

MRI:

Magnetic resonance imaging

NLR:

Negative likelihood ratio

PLR:

Positive likelihood ratio

QUADAS-2:

Quality assessment of diagnostic accuracy studies-2

SNR:

Signal-to-noise ratio

SROC:

Summary receiver operating characteristics

TN:

True-negative

TP:

True-positive

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Acknowledgement

This study was funded by National Natural Science Foundation of China (Grant Number 81471658).

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    Authors and Affiliations

    1. Department of Radiology, Sichuan University West China Hospital, No. 37 Guoxue Alley, Chengdu, Sichuan, China

      Hanyu Jiang, Jie Chen, Ronghui Gao, Zixing Huang, Mingpeng Wu & Bin Song

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    1. Hanyu Jiang
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    2. Jie Chen
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    3. Ronghui Gao
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    Correspondence to Bin Song.

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    Hanyu Jiang and Jie Chen have contributed equally to this work.

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    Jiang, H., Chen, J., Gao, R. et al. Liver fibrosis staging with diffusion-weighted imaging: a systematic review and meta-analysis. Abdom Radiol 42, 490–501 (2017). https://doi.org/10.1007/s00261-016-0913-6

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