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Meta-Analysis
. 2023 Feb 2;18(2):e0271572.
doi: 10.1371/journal.pone.0271572. eCollection 2023.

Diagnostic accuracy of magnetic resonance elastography and point-shear wave elastography for significant hepatic fibrosis screening: Systematic review and meta-analysis

João Paulo L Schambeck  1   2 , Gabriele C Forte  2   3 , Luana M Gonçalves  1   2 , Guilherme Stuker  2 , João Bruno F Kotlinski  3 , Giacomo Tramontin  2 , Stephan Altmayer  1 , Guilherme Watte  4 , Bruno Hochhegger  1   2   4   5
Affiliations
Meta-Analysis

Diagnostic accuracy of magnetic resonance elastography and point-shear wave elastography for significant hepatic fibrosis screening: Systematic review and meta-analysis

João Paulo L Schambeck et al. PLoS One. .

Abstract

The hepatic diseases are extremely common in clinical practice. The correct classification of liver fibrosis is extremely important, as it influences therapy and predicts disease outcomes. The purpose of this study is to compare the diagnostic performance of point-shear wave elastography (pSWE) and magnetic resonance elastography (MRE) in the hepatic fibrosis diagnostic. A meta-analysis was carried out based on articles published until October 2020. The articles are available at following databases: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Scientific Electronic Library Online, LILACS, Scopus, and CINAHL. Diagnostic performances were analyzed per METAVIR F2, using 3.5kPa as target fibrosis. Assessment of the methodological quality of the incorporated papers by the QUADAS-2 tool for pSWE and MRE. A total 2,153 studies articles were evaluated and 44 studies, comprising 6,081 patients with individual data, were included in the meta-analysis: 28 studies for pSWE and 16 studies for MRE. The pooled sensitivity and specificity were 0.86 (95%CI 0.80-0.90) and 0.88 (95%CI 0.85-0.91), respectively, for pSWE, compared with 0.94 (95%CI 0.89-0.97) and 0.95 (95%CI 0.89-0.98) respectively, for MRE. The pooled SROC curve for pSWE shows in the area under the curve (AUC) of 0.93 (95%CI 0.90-0.95), whereas the AUC for MRE was 0.98 (95%CI 0.96-0.99). The diagnostic odds ratio for pSWE and MRE were 41 (95%CI 24-72) and 293 (95%CI 86-1000), respectively. There was statistically significant heterogeneity for pSWE sensitivity (I² = 85.26, P<0.001) and specificity (I² = 89.46, P<0.001). The heterogeneity for MRE also was significant for sensitivity (I² = 73.28, P<0.001) and specificity (I² = 87.24, P<0.001). Therefore, both pSWE and MRE are suitable modalities for assessing liver fibrosis. In addition, MRE is a more accurate imaging technique than pSWE and can be used as alternative to invasive biopsy.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Study selection for meta-analysis.
Point-shear wave elastography (pSWE). MRI = magnetic resonance imaging.
Fig 2
Fig 2
(A) Proportion pSWE and (B) MR elastography studies with low, high, and uncertain risk of bias according to the domains of the QUADAS-2 quality tool.
Fig 3
Fig 3. Forest plot of estimates of sensitivity and specificity of pSWE for diagnosis of hepatic fibrosis.
The 95% confidence intervals (CI) are shown around point estimates and the pooled result. Plots show (A) sensitivity and (B) specificity of pSWE.
Fig 4
Fig 4. Forest plot of estimates of sensitivity and specificity of MR elastography for diagnosis of hepatic fibrosis.
The 95% confidence intervals (CI) are shown around point estimates and the pooled result. Plots show (A) sensitivity and (B) specificity of MR elastography.
Fig 5
Fig 5
(A) Summarized receiver operating characteristic (SROC) curves for pSWE and (B) MRE for the diagnosis of hepatic fibrosis.
Fig 6
Fig 6
(A) Funnel plot for assessment of potential publication bias in the pSWE studies. (B) Funnel plot for the MRE studies.
See this image and copyright information in PMC

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