Diagnostic value of magnetic resonance elastography for detecting and staging of hepatic fibrosis: A meta-analysis
Introduction
Hepatic fibrosis is a common histological process associated with a multitude of liver injuries. Viral, autoimmune, hereditary, metabolic, and toxin-mediated liver disease can result in hepatocellular dysfunction, expansion of the extracellular matrix with distortion of hepatic architecture, portal hypertension, and finally, liver cirrhosis.1 A precise estimation of the degree of liver fibrosis is important for the prediction of prognosis, surveillance, and treatment decision in patients with chronic liver disease.2, 3
The current clinical standard of reference for assessing hepatic fibrosis is liver biopsy,4 and one of the widely used systems for classifying fibrosis is the METAVIR classification system, which generally divides the spectrum of liver fibrosis due to chronic hepatitis into five stages: no fibrosis (F0); portal fibrous expansion (F1); thin fibrous septa emanating from portal triads (F2); fibrous septa bridging portal triads and central veins (F3); and cirrhosis (F4). Clinically significant fibrosis is generally defined as a stage of F2 or greater.5 However, biopsy is an invasive method, and has limitations, such as costs, possible complications, and sampling variability. It is also not an ideal approach for screening, longitudinal monitoring, or assessing therapeutic effect.6, 7 Therefore, considerable research has been conducted to find non-invasive methods for the assessment of hepatic fibrosis.8, 9, 10, 11
Recently, magnetic resonance elastography (MRE) has been developed to non-invasively image the viscoelastic mechanical properties (elasticity or stiffness) of various tissues.12 In an MRE examination, a mechanical driver device is placed in contact with the patient's body wall adjacent to the liver to generate shear waves within the abdomen at a predetermined frequency (typically between 40 and 120 Hz). MR images are acquired with a gradient-echo sequence as the waves propagate through the liver.12 As the liver becomes stiff due to fibrosis, the resulting changes in viscoelastic properties can be measured as changes in shear stiffness by MRE.13 An increasing number of studies have shown MRE to be an accurate method for diagnosing and staging hepatic fibrosis.12, 13
The objective of this study was to assess the overall diagnostic value of MRE for the detection and staging of hepatic fibrosis by performing a meta-analysis with histopathology as a reference standard.
Section snippets
Literature search and study selection
A systematic literature search of PubMed, EMBASE, Web of Science, and the Cochrane Library Database was performed to find the relevant articles assessing MRE for the diagnosis and staging of liver fibrosis published before October 2013. The following search terms were used: liver fibrosis OR hepatic fibrosis; magnetic resonance elastography OR MR elastography OR MRE. The search used free-text words and Medical Subject Headings (MESH) terms to increase the sensitivity of the search strategy. No
Literature search and study selection
After the comprehensive computerized search was performed, 1193 references were acquired, and the number was reduced to 976 after removal of duplicates. According to the inclusion and exclusion criteria, 924 were excluded after reading the title and abstract, and 39 articles were excluded after reviewing the full article. A total of 13 studies20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32 that fulfilled all of the inclusion criteria were considered for the analysis (Table 1). The detailed
Discussion
An accurate assessment of the degree of hepatic fibrosis has therapeutic and prognostic implications. Therefore, the present study was performed to evaluate the applicability of MRE to detect and stage hepatic fibrosis. The present meta-analysis identified 13 eligible diagnostic trials that assessed the diagnostic accuracy of MRE for hepatic fibrosis in patients with chronic liver disease. The pooled DOR for F ≥ 1, F ≥ 2, F ≥ 3, and F = 4 was 68.31 (95% CI = 35.03–133.17), 102.01 (95%
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