Performance of magnetic resonance elastography and diffusion-weighted imaging for the staging of hepatic fibrosis: A meta-analysis

Abstract

A meta-analysis was performed to assess and compare the accuracies of magnetic resonance elastography (MRE) and diffusion-weighted imaging (DWI) for the staging of hepatic fibrosis. Online journal databases and a manual search from January 2000 to May 2011 were used. We identified 41 studies, but only 14 met the criteria to perform a meta-analysis assessing MRE (five trials) or DWI (10 trials). Fibrosis was categorized by redistribution into five stages according to histopathological description. A bivariate binomial model was used to combine the sensitivity and specificity and their 95% confidence intervals (CIs), from which diagnostic odds ratio (DOR), positive likelihood ratio (PLR), negative likelihood ratio (NLR), and summary receiver operating characteristic (sROC) were derived to indicate the diagnostic accuracy of imaging modalities. With MRE, the sensitivity, specificity, DOR, PLR, NLR, and area under sROC curve (with 95% CIs) for staging F0 $ A z test demonstrated that MRE had a significantly higher accuracy than DWI in those indicators (P < 0.05). Conclusion: MRE is more reliable for staging hepatic fibrosis, compared with DWI, with a high combination of sensitivity, specificity, likelihood ratios, DOR, and area under sROC curve. (HEPATOLOGY 2012;56:239-247)

Shear-Wave Elastography for the Estimation of Liver Fibrosis in Chronic Liver Disease: Determining Accuracy and Ideal Site for Measurement

“…Surrogate blood markers and imaging techniques have been shown to help predict liver fibrosis stage with varying degrees of accuracy. Imaging techniques used thus far have included morphologic analysis, computed tomographic (CT) perfusion analysis (9), magnetic resonance (MR) perfusion analysis (10), water diffusion imaging (11,12), and elastography. Ultrasonographic (US) elastography and MR elastography have both shown promising results in several clinical studies (11,(13)(14)(15), with USbased elastography providing the additional advantage of real-time imaging and lower cost.…”

“…Imaging techniques used thus far have included morphologic analysis, computed tomographic (CT) perfusion analysis (9), magnetic resonance (MR) perfusion analysis (10), water diffusion imaging (11,12), and elastography. Ultrasonographic (US) elastography and MR elastography have both shown promising results in several clinical studies (11,(13)(14)(15), with USbased elastography providing the additional advantage of real-time imaging and lower cost. Transient elastography, a vibroacoustic nonimaging technology, and acoustic radiation force imaging, which is an imaging-based technology, have both been shown to be highly accurate for the diagnosis of cirrhosis and of intermediate accuracy for the differentiation of mild and moderate hepatic fibrosis (13)(14)(15).…”

Asian-Pacific Association for the Study of the Liver (APASL) consensus guidelines on invasive and non-invasive assessment of hepatic fibrosis: a 2016 update

“…Consequently, the ADC can be used as a quantitative measure of the extent of fibrosis. A number of studies have examined ADC as a measure of liver fibrosis compared to liver histology, but the best study is a high-quality meta-analysis evaluated with quality assessment for studies of diagnostic accuracy (QUADAS) comparing DWMRI and magnetic resonance elastography (MRE) to liver histology [104]. The pooled estimates inform us that DWMRI has a moderate accuracy, with relatively low sensitivity (below 0.8) for detection of CF2 fibrosis and CF3 fibrosis.…”

“…In vivo MRS examining liver fibrosis has used 31P-MRS. After a standard MR imaging for localization, special MR pulse sequences are applied to generate spectroscopic data within the appropriate anatomical location and volume; a typical examination takes 45-60 min. To date, only small studies with heterogeneous populations have been studied [102][103][104][105]. Consequently, the role of MRS in diagnosis of liver fibrosis/cirrhosis remains undefined.…”

“…MRE has been compared to TE [143] as well as other noninvasive markers of fibrosis [144]. To evaluate the diagnostic capabilities of MRE, two high-quality meta-analyses have been performed comparing MRE with histology as the gold standard and had clearly defined inclusion and exclusion criteria, both using QUADAS scoring to evaluate quality [104,145] (Table 13). Wang et al [104] examined differences based on the following groupings using a 2 9 2 table: F0 versus F1-F4 (score G1), F0 and F1 versus F2-F4 (score G2), F0-F2 versus F3 and F4 (score G3) and F0-F3 versus F4 (score G4).…”