Singh Siddharth, Venkatesh Sudhakar K, Keaveny Andrew, Adam Sharon, Miller Frank H, Asbach Patrick, Godfrey Edmund M, Silva Alvin C, Wang Zhen, Murad Mohammad Hassan, Asrani Sumeet K, Lomas David J, Ehman Richard L
Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.
Department of Radiology, Mayo Clinic, Rochester, MN, USA.
Ann Hepatol. 2016 May-Jun;15(3):363-76. doi: 10.5604/16652681.1198808.
We conducted an individual participant data (IPD) pooled analysis on the diagnostic accuracy of magnetic resonance elastography (MRE) to detect fibrosis stage in liver transplant recipients.
Through a systematic literature search, we identified studies on diagnostic performance of MRE for staging liver fibrosis, using liver biopsy as gold standard. We contacted study authors for published and unpublished IPD on age, sex, body mass index, liver stiffness, fibrosis stage, degree of inflammation and interval between MRE and biopsy; from these we limited analysis to patients who had undergone liver transplantation. Through pooled analysis using nonparametric two-stage receiver-operating curve (ROC) regression models, we calculated the cluster-adjusted AUROC, sensitivity and specificity of MRE for any (≥ stage 1), significant (≥ stage 2) and advanced fibrosis (≥ stage 3) and cirrhosis (stage 4).
We included 6 cohorts (4 published and 2 unpublished series) reporting on 141 liver transplant recipients (mean age, 57 years; 75.2% male; mean BMI, 27.1 kg/m2). Fibrosis stage distribution stage 0, 1, 2, 3, or 4, was 37.6%, 23.4%, 24.8%, 12% and 2.2%, respectively. Mean AUROC values (and 95% confidence intervals) for diagnosis of any (≥ stage 1), significant (≥ stage 2), or advanced fibrosis (≥ stage 3) and cirrhosis were 0.73 (0.66-0.81), 0.69 (0.62-0.74), 0.83 (0.61-0.88) and 0.96 (0.93-0.98), respectively. Similar diagnostic performance was observed in stratified analysis based on sex, obesity and inflammation grade.
In conclusion, MRE has high diagnostic accuracy for detection of advanced fibrosis and cirrhosis in liver transplant recipients, independent of BMI and degree of inflammation.
我们对磁共振弹性成像（MRE）检测肝移植受者纤维化分期的诊断准确性进行了个体参与者数据（IPD）汇总分析。
通过系统的文献检索，我们确定了以肝活检为金标准的关于MRE对肝纤维化分期诊断性能的研究。我们联系了研究作者获取已发表和未发表的关于年龄、性别、体重指数、肝脏硬度、纤维化分期、炎症程度以及MRE与活检之间间隔时间的IPD；从这些数据中，我们将分析限制在接受肝移植的患者。通过使用非参数两阶段受试者操作特征曲线（ROC）回归模型进行汇总分析，我们计算了MRE对任何（≥1期）、显著（≥2期）和重度纤维化（≥3期）以及肝硬化（4期）的聚类调整后的曲线下面积（AUROC）、敏感性和特异性。
我们纳入了6个队列（4个已发表系列和2个未发表系列），报告了141例肝移植受者（平均年龄57岁；75.2%为男性；平均体重指数27.1kg/m²）。纤维化分期分布为0期、1期、2期、3期或4期的比例分别为37.6%、23.4%、24.8%、12%和2.2%。诊断任何（≥1期）、显著（≥2期）、重度纤维化（≥3期）和肝硬化的平均AUROC值（及95%置信区间）分别为0.73（0.66 - 0.81）、0.69（0.62 - 0.74）、0.83（0.61 - 0.88）和0.96（0.93 - 0.98）。在基于性别、肥胖和炎症分级的分层分析中观察到了相似的诊断性能。
总之，MRE对检测肝移植受者的重度纤维化和肝硬化具有较高的诊断准确性，与体重指数和炎症程度无关。
