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Magnetic resonance elastography for staging liver fibrosis in non-alcoholic fatty liver disease: a diagnostic accuracy systematic review and individual participant data pooled analysis

  • Magnetic Resonance
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Abstract

Objectives

We conducted an individual participant data (IPD) pooled analysis on diagnostic accuracy of MRE to detect fibrosis stage in patients with non-alcoholic fatty liver disease (NAFLD).

Methods

Through a systematic literature search, we identified studies of MRE (at 60–62.5 Hz) for staging fibrosis in patients with NAFLD, using liver biopsy as gold standard, and contacted study authors for IPD. Through pooled analysis, we calculated the cluster-adjusted AUROC, sensitivity and specificity of MRE for any (≥stage 1), significant (≥stage 2) and advanced (≥stage 3) fibrosis and cirrhosis (stage 4).

Results

We included nine studies with 232 patients with NAFLD (mean age, 51 ± 13 years; 37.5 % males; mean BMI, 33.5 ± 6.7 kg/m2; interval between MRE and biopsy <1 year, 98.3 %). Fibrosis stage distribution (stage 0/1/2/3/4) was 33.6, 32.3, 10.8, 12.9 and 10.4 %, respectively. Mean AUROC (and 95 % CIs) for diagnosis of any, significant or advanced fibrosis and cirrhosis was 0.86 (0.82–0.90), 0.87 (0.82–0.93), 0.90 (0.84–0.94) and 0.91 (0.76–0.95), respectively. Similar diagnostic performance was observed in stratified analysis based on sex, obesity and degree of inflammation.

Conclusions

MRE has high diagnostic accuracy for detection of fibrosis in NAFLD, independent of BMI and degree of inflammation.

Key points

• MRE has high diagnostic accuracy for detection of fibrosis in NAFLD.

• BMI does not significantly affect accuracy of MRE in NAFLD.

• Inflammation had no significant influence on MRE performance in NAFLD for fibrosis.

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Acknowledgments

We wish to thank Ms. Patricia Erwin, M.L.S., Senior Medical Librarian at the Mayo Clinic Library for helping in the literature search for this systematic review and meta-analysis.

The scientific guarantor of this publication is Sudhakar K. Venkatesh.

The authors of this manuscript declare relationships with the following companies: This work is supported in part by National Institute of Health (NIH) grant EB001981 to MY, JC and RLE and American Gastroenterological Association (AGA) Foundation – Sucampo – ASP Designated Research Award in Geriatric Gastroenterology and by a T. Franklin Williams Scholarship Award and grant K23-DK090303-04 to RL. MY, JC, RLE and the Mayo Clinic have intellectual property relating to the subject and may be eligible for royalties from licensing. RLE is CEO of Resoundant, Inc. This research has been reviewed by the Mayo Clinic Conflict of Interest Review Board and is being conducted in compliance with Mayo Clinic Conflict of Interest policies. None of the other authors have any disclosures. This study received funding from the NIH to RL, MY and JC. Two of the authors have significant statistical expertise. Institutional Review Board approval was obtained. Written informed consent was waived by the Institutional Review Board.

Some study subjects or cohorts have been previously reported in Singh S. et al. (2014) Diagnostic performance of magnetic resonance elastography in staging liver fibrosis: A systematic review and meta-analysis of individual participant data. Clinical Gastroenterology and Hepatology 2015;13:440–451. Methodology: retrospective, observational, multicentre study.

Author information

Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA

    Siddharth Singh & Jayant A. Talwalkar

  2. Department of Radiology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN, 55905, USA

    Sudhakar K. Venkatesh, Jun Chen, Meng Yin & Richard L. Ehman

  3. NAFLD Translational Research Unit, Division of Gastroenterology and Hepatology, Department of Medicine, University of California, San Diego, CA, USA

    Rohit Loomba

  4. Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA

    Zhen Wang & Mohammad Hassan Murad

  5. Liver Imaging Group, Department of Radiology, University of California, San Diego, CA, USA

    Claude Sirlin

  6. Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Frank H. Miller

  7. Sharp and Children’s MRI Center, San Diego, CA, USA

    Russell N. Low

  8. Liver Centers of Southern California, Coronado, CA, USA

    Tarek Hassanein

  9. Department of Radiology, Addenbrooke’s Hospital, Cambridge, UK

    Edmund M. Godfrey & David J. Lomas

  10. Department of Radiology, Charité-Universitätsmedizin Berlin, Charité Campus Mitte, Berlin, Germany

    Patrick Asbach

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  1. Siddharth Singh
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  2. Sudhakar K. Venkatesh
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Corresponding author

Correspondence to Sudhakar K. Venkatesh.

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Supplementary Fig. 1

Cluster-adjusted pooled area under receiver operator curve (AUROC) of MRE for diagnosis of any (≥stage 1), significant (≥stage 2) or advanced (≥stage 3) fibrosis and cirrhosis (GIF 95 kb)

High resolution image (TIFF 154 kb)

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Singh, S., Venkatesh, S.K., Loomba, R. et al. Magnetic resonance elastography for staging liver fibrosis in non-alcoholic fatty liver disease: a diagnostic accuracy systematic review and individual participant data pooled analysis. Eur Radiol 26, 1431–1440 (2016). https://doi.org/10.1007/s00330-015-3949-z

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