Division of Gastroenterology, Department of Internal Medicine, Aichi Medical University School of Medicine, Nagakute, Japan.
Eur Radiol. 2015 Jan;25(1):230-8. doi: 10.1007/s00330-014-3364-x. Epub 2014 Aug 23.
To evaluate the overall accuracy of real-time tissue elastography (RTE) for the staging of liver fibrosis.
We systematically reviewed 15 studies (1,626 subjects) in which sensitivity and specificity of RTE for liver fibrosis are available. For each cut-off stage of fibrosis, i.e., F ≥ 1, F ≥ 2, F ≥ 3, and F ≥ 4, summary sensitivity and specificity were estimated using a bivariate random-effects model. Publication bias was assessed using funnel plots and Egger's test.
Summary sensitivity and specificity were 0.79 and 0.76 for F ≥ 2, 0.82 and 0.81 for F ≥ 3, and 0.74 and 0.84 for F ≥ 4, respectively. Meta-regressions revealed scoring methods of RTE and liver diseases in the samples might not influence sensitivity and specificity of RTE. However, the estimated accuracy of RTE might be overestimated due to publication bias (p = 0.004 for F ≥ 2, p < 0.001 for F ≥ 3, and p = 0.002 for F ≥ 4).
RTE is not highly accurate for any cut-off stage of fibrosis. Compared with findings of meta-analyses on Transient Elastography and Acoustic Radiation Force Impulse imaging, the overall accuracy of RTE seems to be nearly identical for the evaluation of significant liver fibrosis, but less accurate for the evaluation of cirrhosis.
• Non-invasive methods for evaluating liver fibrosis are necessary to replace liver biopsy. • ARFI is as accurate as TE for evaluating liver fibrosis. • RTE may be as accurate as TE and ARFI for fibrosis. • RTE may be less accurate than TE and ARFI for cirrhosis. • The estimated accuracy of RTE may be overestimated by publication bias.
评估实时组织弹性成像（RTE）在肝纤维化分期中的整体准确性。
我们系统地回顾了 15 项研究（1626 名受试者），其中 RTE 对肝纤维化的敏感性和特异性可用。对于每个纤维化分期的截止值，即 F≥1、F≥2、F≥3 和 F≥4，使用双变量随机效应模型估计汇总敏感性和特异性。使用漏斗图和 Egger 检验评估发表偏倚。
F≥2、F≥3 和 F≥4 的汇总敏感性和特异性分别为 0.79 和 0.76、0.82 和 0.81、0.74 和 0.84。元回归显示 RTE 的评分方法和样本中的肝病可能不会影响 RTE 的敏感性和特异性。然而，由于发表偏倚，RTE 的估计准确性可能被高估（F≥2 时 p=0.004，F≥3 时 p<0.001，F≥4 时 p=0.002）。
RTE 对任何纤维化分期的准确性都不高。与瞬态弹性成像和声辐射力脉冲成像的荟萃分析结果相比，RTE 的总体准确性似乎对评估显著肝纤维化几乎相同，但对评估肝硬化的准确性较低。
评估肝纤维化的非侵入性方法是替代肝活检的必要手段。
ARFI 与 TE 一样准确，可用于评估肝纤维化。
RTE 可能与 TE 和 ARFI 一样准确，可用于评估纤维化。
RTE 可能不如 TE 和 ARFI 准确，用于评估肝硬化。
发表偏倚可能高估了 RTE 的估计准确性。
