Diagnostic Performance of Magnetic Resonance Elastography in Staging Liver Fibrosis: A Systematic Review and Meta-analysis of Individual Participant Data

• Published in: Clinical gastroenterology and hepatology Vol. 13; no. 3; pp. 440 - 451.e6
• Main Authors: Singh, Siddharth, Venkatesh, Sudhakar K., Wang, Zhen, Miller, Frank H., Motosugi, Utaroh, Low, Russell N., Hassanein, Tarek, Asbach, Patrick, Godfrey, Edmund M., Yin, Meng, Chen, Jun, Keaveny, Andrew P., Bridges, Mellena, Bohte, Anneloes, Murad, Mohammad Hassan, Lomas, David J., Talwalkar, Jayant A., Ehman, Richard L.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2015
• Subjects: Adult; Aged; Biopsy; Diagnostic Performance; Elasticity Imaging Techniques - methods; Elastography; Female; Gastroenterology and Hepatology; Histocytochemistry; Humans; IPD; Liver - diagnostic imaging; Liver - pathology; Liver Cirrhosis - diagnosis; Male; Middle Aged; Noninvasive; Pooled Analysis; ROC Curve; Sensitivity and Specificity; Pooled Analysis; MRE; NAFLD; LR; AUROC; ARFI; TE; Diagnostic Performance; CLD; HCV; IPD; Noninvasive; Elastography; HBV; QUADAS; BMI; hepatitis B virus; transient elastography; Quality Assessment of Diagnostic Accuracy Studies; likelihood ratio; magnetic resonance elastography; hepatitis C virus; chronic liver disease; individual participant data; body mass index; area under the receiver-operating curve; nonalcoholic fatty liver disease; acoustic radiation force impulse imaging
• DOI: 10.1016/j.cgh.2014.09.046
• ISSN: 1542-3565; 1542-7714

Magnetic resonance elastography (MRE) is a noninvasive tool for staging liver fibrosis. We conducted a meta-analysis of individual participant data collected from published studies to assess the diagnostic accuracy of MRE for staging liver fibrosis in patients with chronic liver diseases (CLD). Through a systematic literature search of multiple databases (2003–2013), we identified studies on diagnostic performance of MRE for staging liver fibrosis in patients with CLD with native anatomy, using liver biopsy as the standard. We contacted study authors to collect data on each participant’s age, sex, body mass index (BMI), liver stiffness (measured by MRE), fibrosis stage, staging system used, degree of inflammation, etiology of CLD, and interval between MRE and biopsy. Through a pooled analysis, we calculated cluster-adjusted area under the receiver-operating curve, sensitivity, and specificity of MRE for any fibrosis (≥stage 1), significant fibrosis (≥stage 2), advanced fibrosis (≥stage 3), and cirrhosis (stage 4). We analyzed data from 12 retrospective studies, comprising 697 patients (mean age, 55 ± 13 y; 59.4% male; mean BMI, 26.9 ± 6.7 kg/m2; 92.1% with <1 year interval between MRE and biopsy; and 47.1% with hepatitis C). Overall, 19.5%, 19.4%, 15.5%, 15.9%, and 29.7% patients had stage 0, 1, 2, 3, and 4 fibrosis, respectively. The mean area under the receiver-operating curve values (and 95% confidence intervals) for the diagnosis of any (≥stage 1), significant (≥stage 2), advanced fibrosis (≥stage 3), and cirrhosis, were as follows: 0.84 (0.76–0.92), 0.88 (0.84–0.91), 0.93 (0.90–0.95), and 0.92 (0.90–0.94), respectively. A similar diagnostic performance was observed in stratified analysis based on sex, obesity, and etiology of CLD. The overall rate of failure of MRE was 4.3%. Based on a pooled analysis of data from individual participants, MRE has a high accuracy for the diagnosis of significant or advanced fibrosis and cirrhosis, independent of BMI and etiology of CLD. Prospective studies are warranted to better understand the diagnostic performance of MRE.