Cynthia Hsu1, Cyrielle Caussy2, Kento Imajo3, Jun Chen4, Siddharth Singh5, Kellee Kaulback6, Minh-Da Le1, Jonathan Hooker7, Xin Tu8, Ricki Bettencourt1, Meng Yin4, Claude B Sirlin7, Richard L Ehman4, Atsushi Nakajima3, Rohit Loomba9. 1. Nonalcoholic Fatty Liver Disease Research Center, Department of Medicine, University of California, San Diego, La Jolla, California. 2. Nonalcoholic Fatty Liver Disease Research Center, Department of Medicine, University of California, San Diego, La Jolla, California; Université Lyon 1, Department of Medicine, Hospices Civils de Lyon, Lyon, France. 3. Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Yokohama, Japan. 4. Department of Radiology, Mayo Clinic, Rochester, Minnesota. 5. Nonalcoholic Fatty Liver Disease Research Center, Department of Medicine, University of California, San Diego, La Jolla, California; Division of Gastroenterology, Department of Medicine, University of California, San Diego, La Jolla, California. 6. Research in Practice, Toronto, Ontario, Canada. 7. Liver Imaging Group, Department of Radiology, University of California, San Diego, La Jolla, California. 8. Division of Biostatistics and Bioinformatics, Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California. 9. Nonalcoholic Fatty Liver Disease Research Center, Department of Medicine, University of California, San Diego, La Jolla, California; Division of Gastroenterology, Department of Medicine, University of California, San Diego, La Jolla, California; Division of Epidemiology, Department of Family and Preventive Medicine, University of California, San Diego, La Jolla, California. Electronic address: roloomba@ucsd.edu.
Abstract
BACKGROUND & AIMS: Magnetic resonance elastography (MRE) and transient elastography (TE) are noninvasive techniques for detection of liver fibrosis. Single-center studies have compared the diagnostic performance of MRE vs TE in patients with nonalcoholic fatty liver disease (NAFLD). We conducted a pooled analysis of individual participant data from published studies to compare the diagnostic performance of MRE vs TE for staging of liver fibrosis in patients with NAFLD, using liver biopsy as reference. METHODS: We performed a systematic search of publication databases, from 2005 through 2017. We identified 3 studies of adults with NAFLD who were assessed by MRE, TE, and liver biopsy. In a pooled analysis, we calculated the cluster-adjusted area under the curve (AUROC) of MRE and TE for the detection of each stage of fibrosis. AUROC comparisons between MRE and TE were performed using the Delong test. RESULTS: Our pooled analysis included 230 participants with biopsy-proven NAFLD with mean age of 52.2±13.9 years and a body mass index of 31.9±7.5 kg/m2. The proportions of patients with fibrosis of stages 0, 1, 2, 3, and 4 were: 31.7%, 27.8%, 15.7%, 13.9%, and 10.9%, respectively. The AUROC of TE vs MRE for detection of fibrosis stages ≥1 was 0.82 (95% CI, 0.76-0.88) vs 0.87 (95% CI, 0.82-0.91) (P=.04); for stage≥ 2 was 0.87 (95% CI, 0.82-0.91) vs 0.92 (95% CI, 0.88-0.96) (P=.03); for stage ≥3 was 0.84 (95% CI, 0.78-0.90) vs 0.93 (95% CI, 0.89-0.96) (P=.001); for stage ≥ 4 was 0.84 (95% CI, 0.73-0.94) vs 0.94 (95% CI, 0.89-0.99) (P=.005). CONCLUSION: In a pooled analysis of data from individual participants with biopsy-proven NAFLD, we found MRE to have a statistically significantly higher diagnostic accuracy than TE in detection of each stage of fibrosis. MRE and TE each have roles in detection of fibrosis in patients with NAFLD, depending upon the level of accuracy desired.
BACKGROUND & AIMS: Magnetic resonance elastography (MRE) and transient elastography (TE) are noninvasive techniques for detection of liver fibrosis. Single-center studies have compared the diagnostic performance of MRE vs TE in patients with nonalcoholic fatty liver disease (NAFLD). We conducted a pooled analysis of individual participant data from published studies to compare the diagnostic performance of MRE vs TE for staging of liver fibrosis in patients with NAFLD, using liver biopsy as reference. METHODS: We performed a systematic search of publication databases, from 2005 through 2017. We identified 3 studies of adults with NAFLD who were assessed by MRE, TE, and liver biopsy. In a pooled analysis, we calculated the cluster-adjusted area under the curve (AUROC) of MRE and TE for the detection of each stage of fibrosis. AUROC comparisons between MRE and TE were performed using the Delong test. RESULTS: Our pooled analysis included 230 participants with biopsy-proven NAFLD with mean age of 52.2±13.9 years and a body mass index of 31.9±7.5 kg/m2. The proportions of patients with fibrosis of stages 0, 1, 2, 3, and 4 were: 31.7%, 27.8%, 15.7%, 13.9%, and 10.9%, respectively. The AUROC of TE vs MRE for detection of fibrosis stages ≥1 was 0.82 (95% CI, 0.76-0.88) vs 0.87 (95% CI, 0.82-0.91) (P=.04); for stage≥ 2 was 0.87 (95% CI, 0.82-0.91) vs 0.92 (95% CI, 0.88-0.96) (P=.03); for stage ≥3 was 0.84 (95% CI, 0.78-0.90) vs 0.93 (95% CI, 0.89-0.96) (P=.001); for stage ≥ 4 was 0.84 (95% CI, 0.73-0.94) vs 0.94 (95% CI, 0.89-0.99) (P=.005). CONCLUSION: In a pooled analysis of data from individual participants with biopsy-proven NAFLD, we found MRE to have a statistically significantly higher diagnostic accuracy than TE in detection of each stage of fibrosis. MRE and TE each have roles in detection of fibrosis in patients with NAFLD, depending upon the level of accuracy desired.
Authors: Paul Angulo; David E Kleiner; Sanne Dam-Larsen; Leon A Adams; Einar S Bjornsson; Phunchai Charatcharoenwitthaya; Peter R Mills; Jill C Keach; Heather D Lafferty; Alisha Stahler; Svanhildur Haflidadottir; Flemming Bendtsen Journal: Gastroenterology Date: 2015-04-29 Impact factor: 22.682
Authors: Jun Chen; Meng Yin; Jayant A Talwalkar; Jennifer Oudry; Kevin J Glaser; Thomas C Smyrk; Véronique Miette; Laurent Sandrin; Richard L Ehman Journal: Radiology Date: 2016-11-18 Impact factor: 11.105
Authors: Meng Yin; Kevin J Glaser; Jayant A Talwalkar; Jun Chen; Armando Manduca; Richard L Ehman Journal: Radiology Date: 2015-07-08 Impact factor: 11.105
Authors: Robert P Myers; Gilles Pomier-Layrargues; Richard Kirsch; Aaron Pollett; Andres Duarte-Rojo; David Wong; Melanie Beaton; Mark Levstik; Pam Crotty; Magdy Elkashab Journal: Hepatology Date: 2011-11-18 Impact factor: 17.425
Authors: Mary Catherine Sawh; Kimberly P Newton; Nidhi P Goyal; Jorge Eduardo Angeles; Kathryn Harlow; Craig Bross; Alexandra N Schlein; Jonathan C Hooker; Ethan Z Sy; Kevin J Glaser; Meng Yin; Richard L Ehman; Claude B Sirlin; Jeffrey B Schwimmer Journal: J Magn Reson Imaging Date: 2019-08-27 Impact factor: 4.813
Authors: Ahmad Moolla; Kenzo Motohashi; Thomas Marjot; Amelia Shard; Mark Ainsworth; Alastair Gray; Rury Holman; Michael Pavlides; John D Ryan; Jeremy W Tomlinson; Jeremy F Cobbold Journal: Frontline Gastroenterol Date: 2019-04-30