Department of Radiology, Sichuan University West China Hospital, Chengdu, Sichuan Province, China.
Department of Radiology, Sichuan University West China Hospital, Chengdu, Sichuan Province, China.
Eur J Radiol. 2020 Mar;124:108839. doi: 10.1016/j.ejrad.2020.108839. Epub 2020 Jan 17.
To determine the diagnostic performance and cutoff value of two-dimensional shear wave elastography (2D SWE) for detecting significant liver fibrosis in patients with chronic hepatitis B (CHB).
A systematic literature search of the PubMed, EMBASE, Cochrane Library databases and Web of Science was conducted. Bivariate modelling and summary receiver-operating-characteristic (ROC) modelling were constructed to summarize the diagnostic performance of 2D SWE. Meta-regression analyses were performed to explore the source of heterogeneity.
Eleven eligible studies with 2623 patients were included. 2D SWE showed a summary sensitivity of 88 % (95 % CI: 83-91), specificity of 83 % (95 % CI: 78-88) and area under the ROC curve of 0.92 (95 % CI: 0.89-0.94) for detecting significant fibrosis in CHB patients. The mean threshold of 2D SWE was 7.91 kPa (range: 6.73-10.00 kPa). Notably, the cutoffs of studies excluding patients with history of prior antiviral therapy were generally lower than that of studies without excluding those who had received antiviral treatment, with an average of 7.15 kPa and 8.87 kPa, respectively (p < 0.01). Meta-regression analysis revealed that enrollment of consecutive patients was the only significant factor influencing heterogeneity (p < 0.01). Specifically, studies recruiting consecutive patients with CHB had significantly lower sensitivity than those with absence of consecutive enrolment (0.83 vs 0.92, p < 0.01).
2D SWE is an excellent modality for predicting significant liver fibrosis in CHB populations. Further work is required to establish the cutoffs that account for antiviral treatment as a potential confounding factor.
评估二维剪切波弹性成像（2D SWE）诊断慢性乙型肝炎（CHB）患者显著肝纤维化的性能和截断值。
系统检索 PubMed、EMBASE、Cochrane Library 数据库和 Web of Science 以获取相关文献。采用双变量模型和汇总受试者工作特征（ROC）曲线模型对 2D SWE 的诊断性能进行总结。进行 Meta 回归分析以探索异质性的来源。
共纳入 11 项符合条件的研究，共计 2623 例患者。2D SWE 诊断 CHB 患者显著纤维化的汇总敏感性为 88%（95%CI：83%-91%），特异性为 83%（95%CI：78%-88%），ROC 曲线下面积为 0.92（95%CI：0.89-0.94）。2D SWE 的平均截断值为 7.91kPa（范围：6.73-10.00kPa）。值得注意的是，排除有既往抗病毒治疗史的患者的研究的截断值通常低于未排除接受抗病毒治疗的患者的研究，分别为 7.15kPa 和 8.87kPa（p<0.01）。Meta 回归分析显示，连续入组患者是影响异质性的唯一显著因素（p<0.01）。具体而言，连续入组 CHB 患者的研究敏感性明显低于无连续入组的研究（0.83 比 0.92，p<0.01）。
2D SWE 是预测 CHB 患者显著肝纤维化的一种优秀方法。需要进一步的研究来建立考虑抗病毒治疗作为潜在混杂因素的截断值。
