The diagnostic accuracy of liver fibrosis in non-viral liver diseases using acoustic radiation force impulse elastography: A systematic review and meta-analysis

Abstract

Background: Acoustic radiation force impulse (ARFI) imaging is an ultrasound-based elastography method that has been studied in the staging of hepatic fibrosis, especially in chronic hepatitis. However, the diagnostic accuracy of ARFI in non-viral hepatopathies, such as autoimmune hepatitis and non-alcoholic fatty liver disease, has not been systematically determined.

Aim: To systematically assess the diagnostic accuracy of ARFI in non-viral hepatopathies.

Methods: The databases of PubMed, Embase, Cochrane Library and clinicaltrials.gov were systematically searched for candidate studies reporting the diagnostic accuracy of ARFI for hepatic fibrosis. The pooled estimates of the sensitivity, specificity, diagnostic odds ratio, and positive and negative likelihood ratios were calculated with the summary receiver operating curve (sROC) performed using STATA software.

Results: In detail, a total of 29 diagnostic studies were included for further analysis. The quality of the included studies was relatively high using QUADAS method. The pooled sensitivity and specificity were 0.79 (0.73, 0.83) and 0.81 (0.75, 0.86), with AUROC 0.87 (0.83, 0.89) for the staging of significant fibrosis (F≥2). Meanwhile, for the staging of severe fibrosis (F≥3), the pooled sensitivity and specificity were 0.92 (0.87, 0.95) and 0.85 (0.80, 0.89), with AUROC 0.94 (0.92, 0.96). Furthermore, the pooled sensitivity and specificity were 0.89 (0.79, 0.95) and 0.89 (0.85, 0.92), with AUROC 0.94 (0.92, 0.96) for ARFI in staging cirrhosis (F = 4), which were similar to the data for severe fibrosis. No significant publication bias was present in this study.

Conclusion: This meta-analysis demonstrated that ARFI exerted satisfactory diagnostic performance in staging non-viral hepatic fibrosis, especially severe fibrosis (F≥3) and cirrhosis (F = 4).

Fig 1. The flow diagram of literature searching and selection of studies according to the PRISMA criteria.

Fig 2. The diagnostic performance of ARFI in staging the significant fibrosis (F≥2).

(A) Forest plot for the pooled estimates of sensitivity and specificity of ARFI on the differentiation of significant fibrosis. (B) Fagan nomogram for the differentiation of significant hepatic fibrosis with ARFI. (C) The summary receiver operating curve (SROC) and corresponding area under ROC (AUROC) for the differentiation of significant hepatic fibrosis with ARFI. (D) Deeks’ funnel plot for the assessment of publication bias. (E) The sROC curve and corresponding AUROC for the differentiation of significant hepatic fibrosis with ARFI in patients with liver transplant. (F) SROC curve and corresponding AUROC for the differentiation of significant hepatic fibrosis with ARFI in patients with non-alcoholic fatty / alcoholic liver diseases (NAFLD or NASH).

Fig 3. The diagnostic performance of ARFI in staging severe fibrosis (F≥3).

(A) Forest plot for the pooled estimates of sensitivity and specificity of ARFI on the differentiation of severe fibrosis. (B) Fagan nomogram for the differentiation of severe hepatic fibrosis with ARFI. (C) The summary receiver operating curve (SROC) and corresponding area under ROC (AUROC) for the differentiation of severe hepatic fibrosis with ARFI. (D) Deeks’ funnel plot for the assessment of publication bias. (E) SROC curve and corresponding AUROC for the differentiation of severe hepatic fibrosis with ARFI in patients with liver transplant. (F) SROC curve and corresponding AUROC for the differentiation of severe hepatic fibrosis with ARFI in patients with NAFLD or NASH.

Fig 4. The diagnostic performance of ARFI in staging cirrhosis (F = 4).

(A) Forest plot for the pooled estimates of sensitivity and specificity of ARFI on the differentiation of cirrhosis. (B) Fagan nomogram for the differentiation of hepatic cirrhosis with ARFI. (C) The summary receiver operating curve (SROC) and corresponding area under ROC (AUROC) for the differentiation of hepatic cirrhosis with ARFI. (D) SROC curve and corresponding AUROC for the differentiation of hepatic cirrhosis with ARFI in patients with NAFLD or NASH.