A meta‐analysis on the diagnostic performance of magnetic resonance imaging and transient elastography in nonalcoholic fatty liver disease

Abstract

Background Noninvasive methods have been used for the assessment of hepatic steatosis in patients with nonalcoholic fatty liver disease (NAFLD). The aim was to assess the efficacy and accuracy of both magnetic resonance imaging(MRI) and transient elastography(TE) for the evaluation of hepatic steatosis. Materials and Methods The PubMed, Cochrane Library, Embase, MEDLINE and Web of Science databases were searched to retrieve studies examining the accuracy of MRI‐proton density fat fraction(PDFF) and TE‐controlled attenuation parameter(CAP) for evaluating the grading of steatosis(S0‐S3) diagnosed by liver biopsy in NAFLD. We compared the sensitivity, specificity, hierarchical summary receiver operating characteristic curves(HSROC) and clinical utility of these methods. Results Twenty‐four articles with a total of 2979 patients with NAFLD were included. The steatosis distribution was 8.1%/35.1%/32.2%/24.6% for S0/S1/S2/S3. For the diagnostic accuracy of MRI‐PDFF, the HSROCs were 0.97 for ≥S1, 0.91 for ≥S2 and 0.90 for ≥S3. For the diagnostic accuracy of TE‐based CAP, the HSROCs were 0.85 for ≥S1, 0.83 for ≥S2 and 0.79 for ≥S3. Following a ‘positive’ measurement (over the threshold value) for ≥S1, the corresponding post‐test probabilities of PDFF and CAP for the presence of steatosis were 82% and 61%, respectively, when the pretest probability was 24%. If the values were below these thresholds (‘negative’ results), the post‐test probabilities were 3% and 7%. Conclusion MRI‐PDFF and TE‐CAP both provide highly accurate noninvasive approaches for quantifying and staging hepatic steatosis in NAFLD. Compared with TE‐CAP, MRI‐PDFF is significantly more accurate for evaluating dichotomized grades of steatosis.

Magnetic Resonance Imaging-Proton Density Fat Fraction vs. Transient Elastography-Controlled Attenuation Parameter in Diagnosing Non-alcoholic Fatty Liver Disease in Children and Adolescents: A Meta-Analysis of Diagnostic Accuracy

“…Moreover, the diagnosis would be wrong in only 5% and 13% of the patients with a "negative" measurement of MRI-PDFF and TE-CAP, respectively. In consistence with the previous articles in adults, this study showed that MRI-PDFF has high accuracy in detecting steatosis of NAFLD (36).…”

“…MRI-PDFF has been shown to be a highly precise, accurate, and reproducible non-invasive method for the quantification of liver fat content (33,34). Furthermore, it has been proven to correlate well with MRS (r 2 = 0.99, p < 0.001) (37) and liver biopsy (36). In addition, MRI-PDFF has been demonstrated to be superior to ultrasound, CT, and TE-CAP in the quantification of liver fat content (13,37).…”

“…However, the suitability of TE-CAP for use in children and reliable indicators for its application remain to be clarified because fewer studies have been conducted in children than in adults (38,39). In a metaanalysis conducted by Gu et al (36), TE-CAP exhibited high performance for the staging of HS in NAFLD. It has been reported that TE-CAP is less influenced by sampling errors than liver biopsies, as TE-CAP explores a liver volume approximately 100 times larger than liver biopsies.…”

“…Several studies have shown that HS in adults can be highly accurately evaluated using TE-CAP and MRI-PDFF ( 2 , 13 , 16 , 17 ). However, only a few studies have reported the use of TE-CAP in diagnosing NAFLD in children and adolescents.…”

NAFLD in type 1 diabetes: overrated or underappreciated?

“…Furthermore, this meta-analysis compared CAP with MRI and concluded that MRI was significantly more accurate to diagnose steatosis. 96 A large individual patient data meta-analysis evaluated the use of the XL probe, which is predominantly used in NAFLD patients due to the link with obesity, and concluded that CAP can help in diagnosing steatosis, but cannot adequately grade steatosis. 97 A Canadian meta-analysis compared all meta-analyses and proposed the following cut-off values: 248 dB/m, 268 dB/m, and 280 dB/m, corrected by BMI and presence of co-morbidities, to respectively diagnose S ⩾ 1, S ⩾ 2, and S3.…”