Meta-analysis: ARFI elastography versus transient elastography for the evaluation of liver fibrosis
Article first published online: 16 JUL 2013
© 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
Volume 33, Issue 8, pages 1138–1147, September 2013
How to Cite
Liver Int. 2013: 33: 1138–1147
- Issue published online: 11 AUG 2013
- Article first published online: 16 JUL 2013
- Accepted manuscript online: 12 JUN 2013 08:34AM EST
- Manuscript Accepted: 27 MAY 2013
- Manuscript Received: 18 JUL 2012
- ARFI ;
- acoustic radiation force impulse elastography;
- liver fibrosis;
- liver stiffness;
- transient elastography
This meta-analysis aims to compare the diagnostic performance of acoustic radiation force impulse (ARFI) elastography and transient elastography (TE) in the assessment of liver fibrosis using liver biopsy (LB) as ‘gold-standard’.
PubMed, Medline, Lilacs, Scopus, Ovid, EMBASE, Cochrane and Medscape databases were searched for all studies published until 31 May 2012 that evaluated the liver stiffness by means of ARFI, TE and LB. Information abstracted from each study according to a fixed protocol included study design and methodological characteristics, patient characteristics, interventions, outcomes and missing outcome data.
Thirteen studies (11 full-length articles and 2 abstracts) including 1163 patients with chronic hepatopathies were included in the analysis. Inability to obtain reliable measurements was more than thrice as high for TE as that of ARFI (6.6% vs. 2.1%, P < 0.001). For detection of significant fibrosis, (F ≥ 2) the summary sensitivity (Se) was 0.74 (95% CI: 0.66–0.80) and specificity (Sp) was 0.83 (95% CI: 0.75–0.89) for ARFI, while for TE the Se was 0.78 (95% CI: 0.72–0.83) and Sp was 0.84 (95% CI: 0.75–0.90). For the diagnosis of cirrhosis, the summary Se was 0.87 (95% CI: 0.79–0.92) and Sp was 0.87 (95% CI: 0.81–0.91) for ARFI elastography, and, respectively, 0.89 (95% CI: 0.80–0.94) and 0.87 (95% CI: 0.82–0.91) for TE. The diagnostic odds ratio of ARFI and TE did not differ significantly in the detection of significant fibrosis [mean difference in rDOR = 0.27 (95% CI: 0.69–0.14)] and cirrhosis [mean difference in rDOR = 0.12 (95% CI: 0.29–0.52)].
Acoustic radiation force impulse elastography seems to be a good method for assessing liver fibrosis, and shows higher rate of reliable measurements and similar predictive value to TE for significant fibrosis and cirrhosis.