Comparison of diagnostic accuracy of magnetic resonance elastography and Fibroscan for detecting liver fibrosis in chronic hepatitis B patients: A systematic review and meta-analysis

Xiao, Hang; Shi, Meijie; Xie, Yubao; Chi, Xiaoling

doi:10.1371/journal.pone.0186660

Cited by 71 publications

(49 citation statements)

References 39 publications

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“…It has been reported that the proposed cutoff values ranged from 5.2 to 8.7 kPa to diagnose significant fibrosis, 8.1 to 10.5 kPa to diagnose advanced fibrosis, and 9.4 to 14 kPa to diagnose cirrhosis. 6,18,19 In our study, the calculated cutoff values (9.9 kPa for significant fibrosis, 10.5 kPa for advanced fibrosis, and 11.2 kPa for cirrhosis) were between the corresponding ranges except the cutoff value for diagnosing significant fibrosis. LSM was found to be influenced by liver inflammation, 8,20 and there were 59.0% (328/ 556) patients with moderate to severe inflammation (HAI ≥ 5) in the present study.…”

Section: Discussionmentioning

confidence: 52%

Declining in liver stiffness cannot indicate fibrosis regression in patients with chronic hepatitis B: A 78‐week prospective study

Dong

Zhao

et al. 2018

J of Gastro and Hepatol

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Background and Aim Little reliable data are available about the liver stiffness measurement (LSM) for fibrosis monitoring in chronic hepatitis B (CHB) patients on antiviral therapy. We aimed to assess the accuracy of LSM in fibrosis monitoring during 78‐week antiviral therapy in CHB patients. Methods Five hundred fifty‐six treatment‐naïve CHB patients with qualified LSM and liver biopsy at baseline were analyzed. Patients receiving entecavir‐based therapy were prospectively followed to 78 weeks for second LSM and liver biopsy. Serologic detection, LSM, and liver biopsy were performed on the same day. Necro‐inflammatory activity was also evaluated. Results Areas under receiver operating characteristics curves of LSM at baseline and week 78 for significant fibrosis (≥ F3), advanced fibrosis (≥ F4), and liver cirrhosis (≥ F5) was 0.84, 0.87, 0.83 and 0.76, 0.85, 0.88, respectively. Patients with the same fibrosis stage but higher histology activity index score tend to have higher LSM at baseline. Liver stiffness decreased rapidly (3.8 [1.6–8.6] kPa) in parallel with baseline histology activity index scores from 11.3 (7.8–16.7) kPa at baseline to 6.4 (5.1–8.8) kPa at week 78. Greater decline of LSM in patients with only inflammation improvement was observed as compared with those without inflammation improvement (5.2 [2.5–9.7] vs 1.8 [0.2–8.1] kPa, P = 0.013). Baseline Ishak fibrosis score was the only predictor of 78‐week fibrosis improvement (odds ratio, 1.859; P = 0.000). Conclusions In CHB patients receiving 78‐week antiviral treatment, LSM could diagnosis different liver fibrosis stages, decrease in absolute LSM value could reflect the remission of liver inflammation, and baseline Ishak fibrosis score was the only predictor for 78‐week fibrosis reversion.

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Section: Discussionmentioning

confidence: 52%

Declining in liver stiffness cannot indicate fibrosis regression in patients with chronic hepatitis B: A 78‐week prospective study

Dong

Zhao

et al. 2018

J of Gastro and Hepatol

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“…+++++AUC ≥0.90, ++++AUC 0.85–0.89, +++AUC 0.80–0.84, ++AUC 0.75–0.79, +AUC <0.75 (Harrell’s c index substituted for AUC for prognostic category).ICC based on phantoms for sonographic elastography techniques128 and patients for MRE 47*Accuracy for determining advanced (bridging) fibrosis abstracted from meta-analyses where available or large patient cohorts 24 27 54 55 129†Proportion of cases falling within an indeterminate range for the prediction of advanced fibrosis 124 130…”

Section: Elastographymentioning

confidence: 99%

“…*Accuracy for determining advanced (bridging) fibrosis abstracted from meta-analyses where available or large patient cohorts 24 27 54 55 129…”

Section: Elastographymentioning

confidence: 99%

“…Obesity, hepatic inflammation and degree of steatosis does not impact on accuracy in NAFLD, however, increased LSMs are observed with hepatic inflammation in chronic viral hepatitis B and C 49–52. The number of comparative studies examining MRE and sonographic elastography techniques is also limited, however, data to date demonstrates MRE to have significantly greater accuracy than VCTE and pSWE in NAFLD,53 and is more accurate than VCTE in CHB 9 54 55. Other MR techniques using diffusion weighted imaging or contrast have also been assessed as diagnostic tests for liver fibrosis, however, appear to be less accurate than MRE 56 57…”

Section: Elastographymentioning

confidence: 99%

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Advances in non-invasive assessment of hepatic fibrosis

Loomba

Adams

2020

Gut

239

172

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Liver fibrosis should be assessed in all individuals with chronic liver disease as it predicts the risk of future liver-related morbidity and thus need for treatment, monitoring and surveillance. Non-invasive fibrosis tests (NITs) overcome many limitations of liver biopsy and are now routinely incorporated into specialist clinical practice. Simple serum-based tests (eg, Fibrosis Score 4, non-alcoholic fatty liver disease Fibrosis Score) consist of readily available biochemical surrogates and clinical risk factors for liver fibrosis (eg, age and sex). These have been extensively validated across a spectrum of chronic liver diseases, however, tend to be less accurate than more ‘complex’ serum tests, which incorporate direct measures of fibrogenesis or fibrolysis (eg, hyaluronic acid, N-terminal propeptide of type three collagen). Elastography methods quantify liver stiffness as a marker of fibrosis and are more accurate than simple serum NITs, however, suffer increasing rates of unreliability with increasing obesity. MR elastography appears more accurate than sonographic elastography and is not significantly impacted by obesity but is costly with limited availability. NITs are valuable for excluding advanced fibrosis or cirrhosis, however, are not sufficiently predictive when used in isolation. Combining serum and elastography techniques increases diagnostic accuracy and can be used as screening and confirmatory tests, respectively. Unfortunately, NITs have not yet been demonstrated to accurately reflect fibrosis change in response to treatment, limiting their role in disease monitoring. However, recent studies have demonstrated lipidomic, proteomic and gut microbiome profiles as well as microRNA signatures to be promising techniques for fibrosis assessment in the future.

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“…Finally, we were not able to compare VCTE to other serum algorithms or magnetic resonance elastography. (40) Notwithstanding these limitations, our study is one of very few studies on noninvasive assessment compared with liver histology in this understudied population.…”

Section: Discussionmentioning

confidence: 93%

Evaluating Noninvasive Markers to Identify Advanced Fibrosis by Liver Biopsy in HBV/HIV Co‐infected Adults

et al. 2019

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Noninvasive biomarkers are used increasingly to assess fibrosis in patients with chronic liver disease. We determined the utility of dual cutoffs for noninvasive biomarkers to exclude and confirm advanced fibrosis in hepatitis B virus (HBV)–human immunodeficiency virus (HIV) co‐infected patients receiving combined antiretroviral therapy. Participants were anti‐HIV/hepatitis B surface antigen–positive adults from eight clinical sites in the United States and Canada of the Hepatitis B Research Network. Fibrosis was staged by a central pathology committee using the Ishak fibrosis score (F). Clinical, laboratory, and vibration‐controlled transient elastography (VCTE) data were collected at each site. Dual cutoffs for three noninvasive biomarkers (aspartate aminotransferase‐to‐platelet ratio index, Fibrosis‐4 index [FIB‐4], and liver stiffness by VCTE) with the best accuracy to exclude or confirm advanced fibrosis (F ≥ 3) were determined using established methodology. Of the 139 enrolled participants, 108 with a liver biopsy and having at least one noninvasive biomarker were included: 22% had advanced fibrosis and 54% had normal alanine aminotransferase. The median (interquartile range) of APRI (n = 106), FIB‐4 (n = 106), and VCTE (n = 63) were 0.34 (0.26‐0.56), 1.35 (0.99‐1.89), and 4.9 (3.8‐6.8) kPa, respectively. The area under the curve for advanced fibrosis was 0.69 for APRI, 0.66 for FIB‐4, and 0.87 for VCTE. VCTE cutoffs of 5.0 kPa or less (to exclude) and 8.8 kPa or greater (to confirm) advanced fibrosis had a sensitivity of 92.3% and specificity of 96.0%, respectively, and accounted for 65.1% of participants. Among the 34.9% with values between the cutoffs, 26.1% had advanced fibrosis. Considering APRI or FIB‐4 jointly with VCTE did not improve the discriminatory capacity. Conclusion: VCTE is a better biomarker of advanced fibrosis compared with APRI or FIB‐4 in HBV/HIV co‐infected adults on combined antiretroviral therapy. Using VCTE dual cutoffs, approximately two‐thirds of patients could avoid biopsy to determine advanced fibrosis.

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Comparison of diagnostic accuracy of magnetic resonance elastography and Fibroscan for detecting liver fibrosis in chronic hepatitis B patients: A systematic review and meta-analysis

Cited by 71 publications

References 39 publications

Declining in liver stiffness cannot indicate fibrosis regression in patients with chronic hepatitis B: A 78‐week prospective study

Declining in liver stiffness cannot indicate fibrosis regression in patients with chronic hepatitis B: A 78‐week prospective study

Advances in non-invasive assessment of hepatic fibrosis

Evaluating Noninvasive Markers to Identify Advanced Fibrosis by Liver Biopsy in HBV/HIV Co‐infected Adults

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