{A figure is presented}Ultrasound-Based Transient Elastography for the Detection of Hepatic Fibrosis: Systematic Review and Meta-analysis

Jayant A. Talwalkar, David M. Kurtz, Scott J. Schoenleber, Colin Patrick West, Victor Manuel Montori

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Abstract

Background & Aims: Ultrasound-based transient elastography is a promising noninvasive alternative to liver biopsy for detecting hepatic fibrosis. However, its overall test performance in various settings remains unknown. The aims of this study were to perform a systematic review and meta-analysis of diagnostic accuracy studies comparing ultrasound-based transient elastography with liver biopsy for hepatic fibrosis. Methods: Electronic and manual bibliographic searches to identify potential studies were performed. Selection of studies was based on reported accuracy of ultrasound-based transient elastography compared with liver biopsy. Data extraction was performed independently by 2 reviewers. Meta-analysis combined the sensitivities, specificities, and likelihood ratios of individual studies. Extent and reasons for heterogeneity were assessed. Results: Nine studies in full publication were identified. For patients with stage IV fibrosis (cirrhosis), the pooled estimates for sensitivity were 87% (95% confidence interval [CI], 84%-90%), specificity 91% (95% CI, 89%-92%), positive likelihood ratio 11.7 (95% CI, 7.9-17.1), and negative likelihood ratio 0.14 (95% CI, 0.10-0.20). Among 7 investigations reporting patients with stages II-IV fibrosis, the pooled estimates for sensitivity were 70% (95% CI, 67%-73%), specificity 84% (95% CI, 80%-88%), positive likelihood ratio 4.2 (95% CI, 2.4-7.2), and negative likelihood ratio 0.31 (95% CI, 0.23-0.43). Diagnostic threshold (or cut-off value) bias was identified as an important cause of heterogeneity for pooled results in both patient groups. Conclusions: Ultrasound-based transient elastography appears to be a clinically useful test for detecting cirrhosis.

Original languageEnglish (US)
Pages (from-to)1214-1220
Number of pages7
JournalClinical Gastroenterology and Hepatology
Volume5
Issue number10
DOIs
StatePublished - Oct 2007

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Elasticity Imaging Techniques
Meta-Analysis
Fibrosis
Confidence Intervals
Liver
Biopsy
Publications
Sensitivity and Specificity

ASJC Scopus subject areas

  • Gastroenterology
  • Medicine(all)

Cite this

{A figure is presented}Ultrasound-Based Transient Elastography for the Detection of Hepatic Fibrosis : Systematic Review and Meta-analysis. / Talwalkar, Jayant A.; Kurtz, David M.; Schoenleber, Scott J.; West, Colin Patrick; Montori, Victor Manuel.

In: Clinical Gastroenterology and Hepatology, Vol. 5, No. 10, 10.2007, p. 1214-1220.

Research output: Contribution to journalArticle

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abstract = "Background & Aims: Ultrasound-based transient elastography is a promising noninvasive alternative to liver biopsy for detecting hepatic fibrosis. However, its overall test performance in various settings remains unknown. The aims of this study were to perform a systematic review and meta-analysis of diagnostic accuracy studies comparing ultrasound-based transient elastography with liver biopsy for hepatic fibrosis. Methods: Electronic and manual bibliographic searches to identify potential studies were performed. Selection of studies was based on reported accuracy of ultrasound-based transient elastography compared with liver biopsy. Data extraction was performed independently by 2 reviewers. Meta-analysis combined the sensitivities, specificities, and likelihood ratios of individual studies. Extent and reasons for heterogeneity were assessed. Results: Nine studies in full publication were identified. For patients with stage IV fibrosis (cirrhosis), the pooled estimates for sensitivity were 87{\%} (95{\%} confidence interval [CI], 84{\%}-90{\%}), specificity 91{\%} (95{\%} CI, 89{\%}-92{\%}), positive likelihood ratio 11.7 (95{\%} CI, 7.9-17.1), and negative likelihood ratio 0.14 (95{\%} CI, 0.10-0.20). Among 7 investigations reporting patients with stages II-IV fibrosis, the pooled estimates for sensitivity were 70{\%} (95{\%} CI, 67{\%}-73{\%}), specificity 84{\%} (95{\%} CI, 80{\%}-88{\%}), positive likelihood ratio 4.2 (95{\%} CI, 2.4-7.2), and negative likelihood ratio 0.31 (95{\%} CI, 0.23-0.43). Diagnostic threshold (or cut-off value) bias was identified as an important cause of heterogeneity for pooled results in both patient groups. Conclusions: Ultrasound-based transient elastography appears to be a clinically useful test for detecting cirrhosis.",
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AU - West, Colin Patrick

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