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. 2025 Jun 2:58:e20240108.
doi: 10.1590/0100-3984.2024.0108. eCollection 2025 Jan-Dec.

Liver stiffness assessed by elastography for the evaluation of hepatocellular carcinoma risk in patients with fibrosis: a systematic review and meta-analysis

Marielle Malucelli Mallmann  1 , Fernando Linhares Pereira  2 , Maria Cristina Chammas  2 , Márcio Luís Duarte  3   4 , Ana Maria Andrade  1 , Emilton Lima Júnior  1 , Odery Ramos Júnior  1
Affiliations

Liver stiffness assessed by elastography for the evaluation of hepatocellular carcinoma risk in patients with fibrosis: a systematic review and meta-analysis

Marielle Malucelli Mallmann et al. Radiol Bras. .

Abstract
in English, Portuguese

This study aimed to systematically review the highest-quality evidence regarding the cutoff value in kPa for the diagnostic accuracy of ultrasound-based liver elastography in comparison with reference standards, including magnetic resonance imaging (MRI), computed tomography, and liver biopsy. In addition, we assessed the presence of hepatocellular carcinoma (HCC) and its associated implications in clinical and diagnostic contexts. We conducted a search using Medical Subject Headings across PubMed, Embase, Cochrane Library, Web of Science, Scopus, and Lilacs for articles published up to June 6, 2024. Of 1,131 studies identified, 33 were eligible and 8 met the quality criteria, as evaluated with the "RTI Item Bank" and "QUADAS-2" tools, following the PICO strategy. The mean elasticity of the liver parenchyma among patients with confirmed HCC was 18.77 kPa (95% CI: 16.28-21.27), making ultrasound liver elastography useful as a predictor of the diagnosis by gold-standard methods such as MRI. Ultrasound elastography is a low-cost, accessible, and noninvasive diagnostic tool capable of estimating liver elasticity in patients with HCC. However, due to the heterogeneity of the articles included in this review, further prospective studies are needed in order to confirm and standardize a cutoff stiffness value for early HCC screening, which could improve patient outcomes, particularly in resource-limited settings.

Este estudo teve como objetivo revisar, sistematicamente, as melhores evidências disponíveis sobre o valor de corte em kPa para o rendimento diagnóstico da elastografia hepática por ultrassom em comparação com métodos de referência, como a ressonância magnética, a tomografia computadorizada e a biópsia hepática, além de avaliar a presença de carcinoma hepatocelular (CHC) e suas implicações no contexto clínico e diagnóstico. Uma busca utilizando os termos Medical Subject Headings foi realizada nas bases PubMed, Embase, Cochrane Library, Web of Science, Scopus e Lilacs para artigos publicados até 6 de junho de 2024. De 1.131 estudos, 33 foram considerados elegíveis e 8 atenderam aos critérios de qualidade usando as ferramentas “RTI Item Bank” e “QUADAS-2”, seguindo a estratégia PICO. A elasticidade média do parênquima hepático foi 18,77 kPa (IC 95%: 16,28-21,27) para a detecção de CHC em comparação à ressonância magnética. A elastografia hepática por ultrassom é uma ferramenta diagnóstica de baixo custo, acessível e não invasiva, capaz de estimar a elasticidade hepática em pacientes com CHC. No entanto, em razão da heterogeneidade desta revisão, mais estudos prospectivos são necessários para confirmar e padronizar um valor de corte em kPa para a triagem precoce do CHC, o que poderia melhorar os resultados dos pacientes, especialmente em ambientes com recursos limitados.

Keywords: Carcinoma; Elasticity imaging techniques; Liver neoplasms/diagnostic imaging.; hepatocellular.

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Figures

Figure 1
Figure 1
2D-SWE assessment of liver elasticity in MASLD without evidence of fibrosis.
Figure 2
Figure 2
Increased propagation speeds of shear waves, representing cirrhosis.
Figure 3
Figure 3
Flow chart of the article selection process.
Figure 4
Figure 4
Forest plots of the sensitivity and specificity of 2D-SWE and p-SWE.
Figure 5
Figure 5
Funnel plots of the standard error of the study data.
See this image and copyright information in PMC

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