Abstract
BackgroundIn order to better monitor non-alcoholic fatty liver disease (NAFLD) patients at higher risk for HCC, there is a need for non-invasive diagnostic approaches to screen for the presence of advanced fibrosis in these patients. The aim of this systematic review and meta-analysis will be to evaluate the diagnostic efficacy of ARFI elastography in detecting hepatic fibrosis in NAFLD patients.MethodsRelevant studies were identified from systematic searches of several major electronic databases (PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials). The primary outcomes were the summary sensitivity, summary specificity, the diagnostic odds ratio, and the summary receiver operating characteristic curve (SROC) of ARFI elastography in detecting significant fibrosis (defined as 4>F≥2) in NAFLD patients. Study quality was assessed using the Quality Assessment of Studies of Diagnostic Accuracy included in Systematic Review (QUADAS-2).ResultsThe summary sensitivity and specificity of ARFI in detecting significant fibrosis were 80.2% (95% confidence interval (CI): 0.758–0.842; p = 0.0000) and 85.2% (95% CI: 0.808–0.890), p = 0.1617), respectively. The pooled diagnostic odds ratio of ARFI in detecting significant fibrosis was 30.13 (95% CI: 12.08–75; chi-squared = 14.59, p = 0.0237). The area under the SROC curve (AUC) was 0.898 (standard error (SE): 0.031) with a Q* index of 0.830 (SE: 0.033).ConclusionsARFI elastography appears to be modestly accurate in detecting significant fibrosis in NAFLD patients. Future studies in this field should provide head-to-head comparisons of ARFI elastography versus other elastographic imaging modalities in NAFLD patients.
Highlights
Non-alcoholic fatty liver disease (NAFLD) is characterized by hepatic steatosis in the absence of secondary causes such as high alcohol consumption, medication use, or hereditary factors and has been clinically associated with metabolic disorders such as obesity, diabetes mellitus, and dyslipidemia [1]
acoustic radiation force impulse (ARFI) elastography appears to be modestly accurate in detecting significant fibrosis in non-alcoholic fatty liver disease (NAFLD) patients
The NAFLD Fibrosis Score is based on readily-available variables that are typically collected as part of the routine check-up for NAFLD patients, elastographic imaging modalities for liver stiffness have an inherent advantage in terms of immediacy over more complex biomarker assays such as Enhanced Liver Fibrosis (ELF) and CK-18, as elastography does not require the time-consuming blood sampling and laboratory processing
Summary
Non-alcoholic fatty liver disease (NAFLD) is characterized by hepatic steatosis in the absence of secondary causes such as high alcohol consumption, medication use, or hereditary factors and has been clinically associated with metabolic disorders such as obesity, diabetes mellitus, and dyslipidemia [1]. In order to better monitor NAFLD patients at higher risk for HCC, there is a need for non-invasive diagnostic approaches to screen for the presence of advanced fibrosis in these patients. To this end, several non-invasive methods to identify advanced fibrosis in NAFLD patients have been investigated, including the NAFLD Fibrosis Score (based on age, BMI, hyperglycemia, platelet count, albumin, and aspartate aminotransferase/alanine aminotransferase [AST/ ALT] ratio), the Enhanced Liver Fibrosis (ELF) panel (based on plasma levels of hyaluronic acid, TIMP-1, and PIIINP), plasma levels of cytokeratin-18 (CK18) fragments, and liver stiffness measurement by elastographic imaging methods (e.g., transient elastography, real-time transient elastography (RTE), acoustic radiation force impulse (ARFI) elastography, and magnetic resonance elastography (MRE)) [1, 3, 4]. In order to better monitor non-alcoholic fatty liver disease (NAFLD) patients at higher risk for HCC, there is a need for non-invasive diagnostic approaches to screen for the presence of advanced fibrosis in these patients. The aim of this systematic review and meta-analysis will be to evaluate the diagnostic efficacy of ARFI elastography in detecting hepatic fibrosis in NAFLD patients
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