Use of shear wave elastography for the diagnosis and follow-up of biliary atresia: A meta-analysis

Abstract

BACKGROUND Timely differentiation of biliary atresia (BA) from other infantile cholestatic diseases can impact patient outcomes. Additionally, non-invasive staging of fibrosis after Kasai hepatoportoenterostomy has not been widely standardized. Shear wave elastography is an ultrasound modality that detects changes in tissue stiffness. The authors propose that the utility of elastography in BA can be elucidated through meta-analysis of existing studies. AIM To assess the utility of elastography in: (1) BA diagnosis, and (2) post-Kasai fibrosis surveillance. METHODS A literature search identified articles that evaluated elastography for BA diagnosis and for post-Kasai follow-up. Twenty studies met criteria for meta-analysis: Eleven for diagnosis and nine for follow-up post-Kasai. Estimated diagnostic odds ratio (DOR), sensitivity, and specificity of elastography were calculated through a random-effects model using Meta-DiSc software. RESULTS Mean liver stiffness in BA infants at diagnosis was significantly higher than in non-BA, with overall DOR 24.61, sensitivity 83%, and specificity 79%. Post-Kasai, mean liver stiffness was significantly higher in BA patients with varices than in patients without, with DOR 16.36, sensitivity 85%, and specificity 76%. Elastography differentiated stage F4 fibrosis from F0-F3 with DOR of 70.03, sensitivity 96%, and specificity 89%. Elastography also differentiated F3-F4 fibrosis from F0-F2 with DOR of 24.68, sensitivity 85%, and specificity 81%. CONCLUSION Elastography has potential as a non-invasive modality for BA diagnosis and surveillance post-Kasai. This paper’s limitations include inter-study method heterogeneity and small sample sizes. Future, standardized, multi-center studies are recommended.

Diagnostic Efficacy of Advanced Ultrasonography Imaging Techniques in Infants with Biliary Atresia (BA): A Systematic Review and Meta-Analysis

“…The current study observed a good diagnostic performance of SWE with the pooled sensitivity of 0.83 (95% CI: 0.81–0.84), specificity of 0.77 (95% CI: 0.75–0.79), AUC of 0.896, and DOR of 22.87 (95% CI: 13.16–39.75) ( Figure 8 a–d). These findings are in agreement with those from a recent meta-analysis by Wagner et al [ 40 ], which evaluated the diagnostic performance of SWE in which high diagnostic accuracy was reported (AUC = 0.91) versus the current study’s AUC of 0.896. The results from the meta-analysis demonstrated that ultrasound-based liver stiffness assessment could be a valuable imaging marker for the diagnosis of infantile biliary atresia.…”

“…A total of thirteen systematic reviews and meta-analysis studies were excluded as they did not meet the publication criteria of original research articles, with some studies reporting the wrong population and index items. These studies consisted of five meta-analyses [ 32 , 33 , 34 , 35 , 36 ], and eight combined systematic reviews and meta-analyses [ 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 ]. Three of the meta-analysis focused on summarising the evidence on the diagnostic performance of various conventional ultrasound parameters for the diagnosis of biliary atresia [ 33 , 34 , 35 ].…”