The Royal Free Sheila Sherlock Liver Centre, Royal Free Hospital, London NW3 2QG, UK.
J Hepatol. 2011 Apr;54(4):650-9. doi: 10.1016/j.jhep.2010.07.033. Epub 2010 Sep 24.
BACKGROUND & AIMS: Transient elastography is a non-invasive method, for the assessment of hepatic fibrosis, developed as an alternative to liver biopsy. We studied the performance of elastography for diagnosis of fibrosis using meta-analysis.
MEDLINE, EMBASE, SCI, Cochrane Library, conference abstracts books, and article references were searched. We included studies using biopsy as a reference standard, with the data necessary to calculate the true and false positive, true and false negative diagnostic results of elastography for a fibrosis stage, and with a 3-month maximum interval between tests. The quality of the studies was rated with the QUADAS tool.
We identified 40 eligible studies. Summary sensitivity and specificity was 0.79 (95% CI 0.74-0.82) and 0.78 (95% CI 0.72-0.83) for F2 stage and 0.83 (95% CI 0.79-0.86) and 0.89 (95% CI 0.87-0.91) for cirrhosis. After an elastography result at/over the threshold value for F2 or cirrhosis ("positive" result), the corresponding post-test probability for their presence (if pre-test probability was 50%) was 78%, and 88% respectively, while, if values were below these thresholds ("negative" result), the post-test probability was 21% and 16%, respectively. No optimal stiffness cut-offs for individual fibrosis stages were validated in independent cohorts and cut-offs had a wide range and overlap within and between stages.
Elastography theoretically has good sensitivity and specificity for cirrhosis (and less for lesser degrees of fibrosis); however, it should be cautiously applied to everyday clinical practice because there is no validation of the stiffness cut-offs for the various stages. Such validation is required before elastography is considered sufficiently accurate for non-invasive staging of fibrosis.
瞬时弹性成像技术是一种非侵入性方法，用于评估肝纤维化，是肝活检的替代方法。我们通过荟萃分析研究了弹性成像技术诊断纤维化的性能。
检索 MEDLINE、EMBASE、SCI、Cochrane 图书馆、会议摘要书籍和文章参考文献。我们纳入了使用活检作为参考标准的研究，这些研究提供了计算弹性成像技术对纤维化分期的真阳性、假阳性、真阴性和假阴性诊断结果所需的数据，且两次检查的最大间隔时间为 3 个月。使用 QUADAS 工具对研究质量进行了评分。
我们确定了 40 项符合条件的研究。对于 F2 期，汇总的敏感性和特异性分别为 0.79（95%CI 0.74-0.82）和 0.78（95%CI 0.72-0.83），对于肝硬化，敏感性和特异性分别为 0.83（95%CI 0.79-0.86）和 0.89（95%CI 0.87-0.91）。在弹性成像结果达到或超过 F2 或肝硬化的阈值（“阳性”结果）后，如果（如果术前概率为 50%）其存在的术后概率分别为 78%和 88%，而如果低于这些阈值（“阴性”结果），术后概率分别为 21%和 16%。在独立队列中未验证单个纤维化分期的最佳硬度截断值，并且截断值在各分期内和分期之间的范围很宽且重叠。
弹性成像技术在诊断肝硬化方面具有良好的敏感性和特异性（在纤维化程度较低时敏感性和特异性较低）；然而，在弹性成像技术被认为可以足够准确地进行纤维化的非侵入性分期之前，应该谨慎将其应用于日常临床实践中，因为尚未对各种分期的硬度截断值进行验证。
