磁共振与瞬时弹性成像分析非酒精性脂肪性肝病患者：系统评价和个体参与者汇总分析。
Magnetic Resonance vs Transient Elastography Analysis of Patients With Nonalcoholic Fatty Liver Disease: A Systematic Review and Pooled Analysis of Individual Participants.
机构信息
Nonalcoholic Fatty Liver Disease Research Center, Department of Medicine, University of California, San Diego, La Jolla, California.
Nonalcoholic Fatty Liver Disease Research Center, Department of Medicine, University of California, San Diego, La Jolla, California; Université Lyon 1, Department of Medicine, Hospices Civils de Lyon, Lyon, France.
出版信息
Clin Gastroenterol Hepatol. 2019 Mar;17(4):630-637.e8. doi: 10.1016/j.cgh.2018.05.059. Epub 2018 Jun 14.
BACKGROUND & AIMS: Magnetic resonance elastography (MRE) and transient elastography (TE) are noninvasive techniques for detection of liver fibrosis. Single-center studies have compared the diagnostic performance of MRE vs TE in patients with nonalcoholic fatty liver disease (NAFLD). We conducted a pooled analysis of individual participant data from published studies to compare the diagnostic performance of MRE vs TE for staging of liver fibrosis in patients with NAFLD, using liver biopsy as reference.
METHODS
We performed a systematic search of publication databases, from 2005 through 2017. We identified 3 studies of adults with NAFLD who were assessed by MRE, TE, and liver biopsy. In a pooled analysis, we calculated the cluster-adjusted area under the curve (AUROC) of MRE and TE for the detection of each stage of fibrosis. AUROC comparisons between MRE and TE were performed using the Delong test.
RESULTS
Our pooled analysis included 230 participants with biopsy-proven NAFLD with mean age of 52.2±13.9 years and a body mass index of 31.9±7.5 kg/m2. The proportions of patients with fibrosis of stages 0, 1, 2, 3, and 4 were: 31.7%, 27.8%, 15.7%, 13.9%, and 10.9%, respectively. The AUROC of TE vs MRE for detection of fibrosis stages ≥1 was 0.82 (95% CI, 0.76-0.88) vs 0.87 (95% CI, 0.82-0.91) (P=.04); for stage≥ 2 was 0.87 (95% CI, 0.82-0.91) vs 0.92 (95% CI, 0.88-0.96) (P=.03); for stage ≥3 was 0.84 (95% CI, 0.78-0.90) vs 0.93 (95% CI, 0.89-0.96) (P=.001); for stage ≥ 4 was 0.84 (95% CI, 0.73-0.94) vs 0.94 (95% CI, 0.89-0.99) (P=.005).
CONCLUSION
In a pooled analysis of data from individual participants with biopsy-proven NAFLD, we found MRE to have a statistically significantly higher diagnostic accuracy than TE in detection of each stage of fibrosis. MRE and TE each have roles in detection of fibrosis in patients with NAFLD, depending upon the level of accuracy desired.
背景与目的
磁共振弹性成像（MRE）和瞬时弹性成像（TE）是用于检测肝纤维化的非侵入性技术。单中心研究已经比较了 MRE 与 TE 在非酒精性脂肪性肝病（NAFLD）患者中的诊断性能。我们对已发表研究的个体参与者数据进行了汇总分析，以比较 MRE 与 TE 在 NAFLD 患者中对肝纤维化分期的诊断性能，以肝活检为参考。
方法
我们对 2005 年至 2017 年的出版物数据库进行了系统搜索。我们确定了 3 项研究，这些研究评估了 MRE、TE 和肝活检的成年人的 NAFLD。在汇总分析中，我们计算了 MRE 和 TE 检测每个纤维化阶段的聚类调整曲线下面积（AUROC）。使用 Delong 检验比较 MRE 和 TE 之间的 AUROC。
结果
我们的汇总分析包括 230 名经活检证实的 NAFLD 患者，平均年龄为 52.2±13.9 岁，体重指数为 31.9±7.5kg/m2。纤维化 0、1、2、3 和 4 期的患者比例分别为：31.7%、27.8%、15.7%、13.9%和 10.9%。TE 与 MRE 检测纤维化≥1 期的 AUROC 分别为 0.82（95%CI，0.76-0.88）与 0.87（95%CI，0.82-0.91）（P=0.04）；≥2 期分别为 0.87（95%CI，0.82-0.91）与 0.92（95%CI，0.88-0.96）（P=0.03）；≥3 期分别为 0.84（95%CI，0.78-0.90）与 0.93（95%CI，0.89-0.96）（P=0.001）；≥4 期分别为 0.84（95%CI，0.73-0.94）与 0.94（95%CI，0.89-0.99）（P=0.005）。
结论
在对经活检证实的 NAFLD 患者个体参与者数据的汇总分析中，我们发现 MRE 在检测每个纤维化阶段方面的诊断准确性均显著高于 TE。MRE 和 TE 在检测 NAFLD 患者的纤维化方面均具有各自的作用，具体取决于所需的准确性水平。
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