| Optimal cut-offs of vibration-controlled transient elastography and magnetic resonance elastography in diagnosing advanced liver fibrosis in patients with nonalcoholic fatty liver disease: A systematic review and meta-analysis |
Young Eun Chon1, Young-Joo Jin2, Jihyun An3, Hee Yeon Kim4, Miyoung Choi5, Dae Won Jun6, Mi Na Kim7,8, Ji Won Han9, Han Ah Lee10, Jung Hwan Yu2
, Seung Up Kim7,8
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1Department of Gastroenterology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
2Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
3Department of Gastroenterology and Hepatology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
4Department of Internal Medicine, College of Medicine, Bucheon St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
5Division of Health Technology Assessment Research, National Evidence-Based Healthcare Collaborating Agency (NECA), Seoul, Korea
6Department of Internal Medicine, Hanyang University Hospital, Hanyang University College of Medicine, Seoul, Korea
7Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
8Yonsei Liver Center, Severance Hospital, Seoul, Korea
9Department of Internal Medicine, College of Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
10Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea |
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Received: May 24, 2024 Revised: August 19, 2024 Accepted: August 20, 2024
*Young Eun Chon and Young-Joo Jin contributed equally to this work. |
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| ABSTRACT |
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Background/aims
Opinions differ regarding vibration-controlled transient elastography and magnetic resonance elastography (VCTE/MRE) cut-offs for diagnosing advanced fibrosis (AF) in patients with non-alcoholic fatty liver disease (NAFLD). We investigated the diagnostic performance and optimal cut-off values of VCTE and MRE for diagnosing AF.
Methods
Literature databases, including Medline, EMBASE, Cochrane Library, and KoreaMed, were used to identify relevant studies published up to June 13, 2023. We selected studies evaluating VCTE and MRE regarding the degree of liver fibrosis using liver biopsy as the reference. The sensitivity, specificity, and area under receiver operating characteristics curves (AUCs) of the pooled data for VCTE and MRE for each fibrosis stage and optimal cut-offs for AF were investigated.
Results
A total of 19,199 patients from 63 studies using VCTE showed diagnostic AUC of 0.83 (95% confidence interval: 0.80–0.86), 0.83 (0.80–0.86), 0.87 (0.84–0.90), and 0.94 (0.91–0.96) for ≥F1, ≥F2, ≥F3, and F4 stages, respectively. Similarly, 1,484 patients from 14 studies using MRE showed diagnostic AUC of 0.89 (0.86–0.92), 0.92 (0.89–0.94), 0.89 (0.86–0.92), and 0.94 (0.91–0.96) for ≥F1, ≥F2, ≥F3, and F4 stages, respectively. The diagnostic AUC for AF using VCTE was highest at 0.90 with a cut-off of 7.1–7.9 kPa, and that of MRE was highest at 0.94 with a cut-off of 3.62–3.8 kPa.
Conclusions
VCTE (7.1–7.9 kPa) and MRE (3.62–3.8 kPa) with the suggested cut-offs showed favorable accuracy for diagnosing AF in patients with NAFLD. This result will serve as a basis for clinical guidelines for non-invasive tests and differential diagnosis of AF. |
| KeyWords:
Non-alcoholic fatty liver disease; Meta-analysis; Advanced fibrosis; Vibration-controlled transient elastography; Magnetic resonance elastography |
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