Ye Zheng, Wei Yi, Chen Jie, Yao Shan, Song Bin
West China School of Medicine, Sichuan University, Chengdu 610041, Sichuan Province, China.
Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China.
World J Gastroenterol. 2020 Jun 21;26(23):3304-3317. doi: 10.3748/wjg.v26.i23.3304.
Liver fibrosis (LF) is a common pathological feature of all chronic liver diseases. With the accumulation of extracellular matrix in the fibrotic liver, true molecular water diffusion and perfusion-related diffusion are restricted. Intravoxel incoherent motion (IVIM) can capture the information on tissue diffusivity and microcapillary perfusion separately and reflect the fibrotic severity with diffusion coefficients.
To investigate the diagnostic performance of IVIM in detecting and staging LF with histology as a reference standard.
A comprehensive literature search was conducted to identify studies on the diagnostic accuracy of IVIM for assessment of histologically proven LF. The stages of LF were classified as F0 (no fibrosis), F1 (portal fibrosis without septa), F2 (periportal fibrosis with few septa), F3 (septal fibrosis), and F4 (cirrhosis) according to histopathological findings. Data were extracted to calculate the pooled sensitivity, specificity, positive and negative likelihood ratios, and diagnostic odds ratio, as well as the area under the summary receiver operating characteristic curve (AUC) in each group.
A total of 12 studies with 923 subjects were included in this meta-analysis with 5 studies ( = 465) for LF ≥ F1, 9 studies ( = 757) for LF ≥ F2, 4 studies ( = 413) for LF ≥ F3, and 6 studies ( = 562) for LF = F4. The pooled sensitivity and specificity were estimated to be 0.78 (95% confidence interval: 0.73-0.82) and 0.81 (0.74-0.86) for LF ≥ F1 detection with IVIM; 0.82 (0.79-0.86) and 0.80 (0.75-0.84) for staging F2 fibrosis; 0.85 (0.79-0.90) and 0.83 (0.77-0.87) for staging F3 fibrosis, and 0.90 (0.84-0.94) and 0.75 (0.70-0.79) for detecting F4 cirrhosis, respectively. The AUCs for LF ≥ F1, F2, F3, F4 detection were 0.862 (0.811-0.914), 0.883 (0.856-0.909), 0.886 (0.865-0.907), and 0.899 (0.866-0.932), respectively. Moderate to substantial heterogeneity was observed with inconsistency index ( ) ranging from 0% to 77.9%. No publication bias was detected.
IVIM is a noninvasive tool with good diagnostic performance in detecting and staging LF. Optimized and standardized IVIM protocols are needed to further improve its diagnostic accuracy in clinical practice.
肝纤维化（LF）是所有慢性肝病的常见病理特征。随着纤维化肝脏中细胞外基质的积累，真正的分子水扩散和灌注相关扩散受到限制。体素内不相干运动（IVIM）可以分别获取组织扩散率和微血管灌注信息，并通过扩散系数反映纤维化严重程度。
以组织学为参考标准，研究IVIM在检测LF及对其进行分期方面的诊断性能。
进行全面的文献检索，以确定关于IVIM评估经组织学证实的LF诊断准确性的研究。根据组织病理学结果，LF分期分为F0（无纤维化）、F1（无间隔的门脉纤维化）、F2（有少量间隔的汇管区周围纤维化）、F3（间隔纤维化）和F4（肝硬化）。提取数据以计算每组的合并敏感性、特异性、阳性和阴性似然比、诊断比值比以及汇总受试者工作特征曲线下面积（AUC）。
本荟萃分析共纳入12项研究923名受试者，其中5项研究（n = 465）针对LF≥F1，9项研究（n = 757）针对LF≥F2，4项研究（n = 413）针对LF≥F3，6项研究（n = 562）针对LF = F4。IVIM检测LF≥F1的合并敏感性和特异性估计分别为0.78（95%置信区间：0.73 - 0.82）和0.81（0.74 - 0.86）；F2期纤维化分期的敏感性和特异性分别为0.82（0.79 - 0.86）和0.80（0.75 - 0.84）；F3期纤维化分期的敏感性和特异性分别为0.85（0.79 - 0.90）和0.83（0.77 - 0.87）；检测F4期肝硬化的敏感性和特异性分别为0.90（0.84 - 0.94）和0.75（0.70 - 0.79）。LF≥F1、F2、F3、F4检测的AUC分别为0.862（0.811 - 0.914）、0.883（0.856 - 0.909）、0.886（0.865 - 0.907）和0.899（0.866 - 0.932）。观察到中度至高度异质性，不一致指数（I²）范围为0%至77.9%。未检测到发表偏倚。
IVIM是一种在检测LF及对其进行分期方面具有良好诊断性能的非侵入性工具。需要优化和标准化IVIM方案以进一步提高其在临床实践中的诊断准确性。
