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Diagnostic Accuracy of Real-Time Tissue Elastography for the Staging of Liver Fibrosis: A Meta-Analysis

  • Gastrointestinal
  • Published:
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Abstract

Objective

To evaluate the overall accuracy of real-time tissue elastography (RTE) for the staging of liver fibrosis.

Methods

We systematically reviewed 15 studies (1,626 subjects) in which sensitivity and specificity of RTE for liver fibrosis are available. For each cut-off stage of fibrosis, i.e., F ≥ 1, F ≥ 2, F ≥ 3, and F ≥ 4, summary sensitivity and specificity were estimated using a bivariate random-effects model. Publication bias was assessed using funnel plots and Egger’s test.

Results

Summary sensitivity and specificity were 0.79 and 0.76 for F ≥ 2, 0.82 and 0.81 for F ≥ 3, and 0.74 and 0.84 for F ≥ 4, respectively. Meta-regressions revealed scoring methods of RTE and liver diseases in the samples might not influence sensitivity and specificity of RTE. However, the estimated accuracy of RTE might be overestimated due to publication bias (p = 0.004 for F ≥ 2, p < 0.001 for F ≥ 3, and p = 0.002 for F ≥ 4).

Conclusions

RTE is not highly accurate for any cut-off stage of fibrosis. Compared with findings of meta-analyses on Transient Elastography and Acoustic Radiation Force Impulse imaging, the overall accuracy of RTE seems to be nearly identical for the evaluation of significant liver fibrosis, but less accurate for the evaluation of cirrhosis.

Key Points

• Non-invasive methods for evaluating liver fibrosis are necessary to replace liver biopsy.

• ARFI is as accurate as TE for evaluating liver fibrosis.

• RTE may be as accurate as TE and ARFI for fibrosis.

• RTE may be less accurate than TE and ARFI for cirrhosis.

• The estimated accuracy of RTE may be overestimated by publication bias.

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Abbreviations

RTE:

Real-time tissue elastography

TE:

Transient Elastography

ARFI:

Acoustic Radiation Force Impulse

SWE:

Shear-Wave Elastography

LFI:

Liver Fibrosis Index

FPR:

False positive ratio

SROC:

Summary Receiver Operating Characteristic Curve

DOR:

Diagnostic odds ratio

CI:

Confidence interval

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Acknowledgments

The scientific guarantor of this publication is Prof. Haruhisa Nakao. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. One of the authors (TN) has significant statistical expertise. Institutional Review Board approval and written consent were not required because this study is a meta-analysis.

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Authors and Affiliations

  1. Division of Gastroenterology, Department of Internal Medicine, Aichi Medical University School of Medicine, Nagakute, Japan

    Kunio Kobayashi, Haruhisa Nakao, Yuji Kobayashi, Takaya Yamamoto, Norimitsu Ishii, Tomohiko Ohashi, Ken Satoh, Yukiomi Nakade, Kiyoaki Ito & Masashi Yoneda

  2. Department of Public Health, Aichi Medical University School of Medicine, 1-1 Yazako, Nagakute, Aichi, 480-1195, Japan

    Takeshi Nishiyama, Yingsong Lin & Shogo Kikuchi

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  1. Kunio Kobayashi
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Correspondence to Takeshi Nishiyama.

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Kobayashi, K., Nakao, H., Nishiyama, T. et al. Diagnostic Accuracy of Real-Time Tissue Elastography for the Staging of Liver Fibrosis: A Meta-Analysis. Eur Radiol 25, 230–238 (2015). https://doi.org/10.1007/s00330-014-3364-x

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  • DOI: https://doi.org/10.1007/s00330-014-3364-x

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