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

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.

Liver Magnetic Resonance Elastography: Focus on Methodology, Technique, and Feasibility

“…Also, the same meta-analysis showed a diagnostic accuracy in detecting liver cirrhosis with an sAUC, sensitivity, and specificity of 0.90, 81%, and 90%, respectively. A meta-analysis by Schambek J.P.L et al [44] analysed the diagnostic performance of MRE and point shear wave elastography (pSWE) with an excellent diagnostic accuracy of MRE in staging METAVIR F2 patients with a pooled sensitivity and specificity of 0.94 and 0.95 in MRE, higher than the pooled sensitivity and specificity of pSWE. In this meta-analysis, MRE proved to be an important tool for the early diagnosis of liver fibrosis, reducing the role of biopsies in F2 fibrosis patients.…”

Ultrasound Elastography: Methods, Clinical Applications, and Limitations: A Review Article

“…Unlike 1D-TE, pSWE utilizes B-mode ultrasound to directly visualize and select the region of interest, whereas 1D-TE is heavily dependent on A-mode ultrasound. pSWE can easily be performed on a conventional ultrasound machine as well, with no need for any special probe or machinery, but it does not have the ability to showcase images of tissue stiffness [52][53][54][55][56][57][58]. See Figure 2.…”

Treatment of liver fibrosis: Past, current, and future

“…For example, ultrasound elastography techniques can be applied to characterize liver fibrosis and its stage in adult patients, such as vibration-controlled transient elastography, the most utilized and validated elastography method[ 86 ]. A meta-analysis study also showed that magnetic resonance elastography (MRE) and point-shear wave elastography (pSWE) can be applied for liver fibrosis diagnostic, and MRE is a more accurate imaging technique than pSWE[ 87 ]. The pooled sensitivities and specificities for MRE and pSWE were 0.94 (95% confidence level/CI: 0.89-0.97) and 0.95 (95%CI: 0.89-0.98), and 0.86 (95%CI: 0.80-0.90) and 0.88 (95%CI: 0.85-0.91), respectively.…”