Diagnostic performance of magnetic resonance elastography in staging liver fibrosis: a systematic review and meta-analysis of individual participant data.
Diagnostic performance of magnetic resonance elastography in staging liver fibrosis: a systematic review and meta-analysis of individual participant data.
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DOI：
10.1016/j.cgh.2014.09.046
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发表时间：
2015-03
期刊：
影响因子：
--
通讯作者：
Ehman RL
中科院分区：
文献类型：
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作者：
Singh S;Venkatesh SK;Wang Z;Miller FH;Motosugi U;Low RN;Hassanein T;Asbach P;Godfrey EM;Yin M;Chen J;Keaveny AP;Bridges M;Bohte A;Murad MH;Lomas DJ;Talwalkar JA;Ehman RL
磁共振弹性成像（MRE）是肝纤维化分期的一种非侵入性工具。我们对从已发表的研究中收集的个体参与者数据进行了荟萃分析，以评估MRE诊断慢性肝病（CLD）患者肝纤维化分期的准确性。通过对多个数据库的系统文献检索（2003-2013），我们发现了以肝活检为标准，MRE对CLD患者肝纤维化分期的诊断性能具有天然解剖特征的研究。我们联系了研究作者，收集了每位参与者的年龄、性别、体重指数（BMI）、肝脏硬度（通过MRE测量）、纤维化分期、使用的分期系统、炎症程度、CLD病因学以及MRE和活检之间的时间间隔的数据。通过合并分析，我们计算了接受者操作曲线下的聚类调整面积（AUROC）、MRE对任何纤维化（≥1期）、显著纤维化（≥2期）、晚期纤维化（≥3期）和肝硬化（4期）的敏感性和特异性。我们分析了12项回顾性研究的数据，包括697例患者（平均年龄55±13岁，男性59.4%，平均BMI 26.9±6.7 kg/m2, 92.1% MRE与活检间隔<1年，丙型肝炎患者占47.1%）。参与者的纤维化分期为0、1、2、3或4期（分别为19.5%、19.4%、15.5%、15.9%和29.7%）。诊断任何（≥1期）、显著（≥2期）或晚期纤维化（≥3期）和肝硬化的平均AUROC值（和95%可信区间）分别为0.84（0.76-0.92）、0.88（0.84 - 0.91）、0.93（0.90-0.95）和0.92（0.90-0.94）。在基于性别、肥胖和CLD病因的分层分析中观察到类似的诊断表现。MRE的总失败率为4.3%。基于对个体参与者数据的汇总分析，MRE在诊断显著或晚期纤维化和肝硬化方面具有很高的准确性，与BMI和CLD病因无关。为了更好地了解MRE的诊断性能，有必要进行前瞻性研究。
Magnetic resonance elastography (MRE) is a non-invasive 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 and 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 pooled analysis, we calculated the cluster-adjusted area under receiver-operating curve (AUROC), 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 years; 59.4% male; mean BMI, 26.9±6.7 kg/m2; 92.1% with <1 year interval between MRE and biopsy; hepatitis C in 47.1%). Participants had fibrosis stages 0, 1, 2, 3, or 4 (19.5%, 19.4%, 15.5%, 15.9% and 29.7%, respectively). Mean AUROC values (and 95% confidence intervals) for diagnosis of any (≥stage 1), significant (≥stage 2), or advanced fibrosis (≥stage 3), and cirrhosis, were 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. 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 pooled analysis of data from individual participants, MRE has high accuracy for 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.