Performance of common imaging techniques vs serum biomarkers in assessing fibrosis in patients with chronic hepatitis B: A systematic review and meta-analysis

Abstract

Background: Noninvasive biomarkers have been developed to predict hepatitis B virus (HBV) related fibrosis owing to the significant limitations of liver biopsy. Both serum biomarkers and imaging techniques have shown promising results and may improve the evaluation of liver fibrosis. However, most of the previous studies focused on the diagnostic effects of various imaging techniques on fibrosis in all chronic liver diseases.

Aim: To compare the performance of common imaging methods and serum biomarkers for prediction of significant fibrosis caused only by HBV infection.

Methods: A systematic review was conducted on the records available in PubMed, EMBASE, and the Cochrane Library electronic databases until December 2018. We systematically assessed the effectiveness of two serum biomarkers and three imagine techniques in predicting significant fibrosis solely caused by HBV infection. The serum biomarkers included aspartate aminotransferase-to-platelet ratio index (APRI) and fibrosis index based on the 4 factors (FIB-4). The three imaging techniques included acoustic radiation force impulse (ARFI), FibroScan, and magnetic resonance elastography (MRE). Three parameters, the area under the summary receiver operating characteristic curve (AUSROC), the summary diagnostic odds ratio, and the summary sensitivity and specificity, were used to examine the accuracy of all tests for liver fibrosis.

Results: Out of 2831 articles evaluated for eligibility, 204 satisfied the predetermined inclusion criteria for this current meta-analysis. Eventually, our final data contained 81 studies. The AUSROCs of serum biomarkers of APRI and FIB-4 were both 0.75. For imaging techniques (ARFI, FibroScan, and MRE), the areas were 0.89, 0.83, and 0.97, respectively. The heterogeneities of ARFI and FibroScan were statistically significant (I ² > 50%). The publication bias was not observed in any of the serum biomarkers or imaging methods.

Conclusion: These five methods have attained an acceptable level of diagnostic accuracy. Imaging techniques, MRE in particular, demonstrate significant advantages in accurately predicting HBV-related significant fibrosis, while serum biomarkers are admissible methods.

Keywords: Diagnostic test; Hepatitis B virus; Imaging technology; Liver fibrosis; Meta-analysis.

Figure 1

Flow diagram of article selection.

Figure 2

Summary of methodological quality of studies according to QUADAS-2.

Figure 3

Meta-analysis of hepatitis B-related significant fibrosis. A: Summary receiver operating characteristic (SROC) curve of the aminotransferase-to-platelet ratio index; B: SROC curve of the fibrosis index based on the 4 factors; C: SROC curve of the acoustic radiation force impulse; D: SROC curve of the FibroScan; E: SROC curve of the MRE. SROC: Summary receiver operating characteristic; APRI: Aminotransferase-to-platelet ratio index; FIB-4: Fibrosis index based on the 4 factors; ARFI: Acoustic radiation force impulse.