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Comparative Study
. 2019 Mar;17(4):630-637.e8.
doi: 10.1016/j.cgh.2018.05.059. Epub 2018 Jun 14.

Magnetic Resonance vs Transient Elastography Analysis of Patients With Nonalcoholic Fatty Liver Disease: A Systematic Review and Pooled Analysis of Individual Participants

Cynthia Hsu  1 , Cyrielle Caussy  2 , Kento Imajo  3 , Jun Chen  4 , Siddharth Singh  5 , Kellee Kaulback  6 , Minh-Da Le  1 , Jonathan Hooker  7 , Xin Tu  8 , Ricki Bettencourt  1 , Meng Yin  4 , Claude B Sirlin  7 , Richard L Ehman  4 , Atsushi Nakajima  3 , Rohit Loomba  9
Affiliations
Comparative Study

Magnetic Resonance vs Transient Elastography Analysis of Patients With Nonalcoholic Fatty Liver Disease: A Systematic Review and Pooled Analysis of Individual Participants

Cynthia Hsu et al. Clin Gastroenterol Hepatol. 2019 Mar.

Abstract

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.

Keywords: Fibroscan; Magnetic Resonance Elastography; NAFLD; Transient Elastography.

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Conflict of interest statement

Conflict of interests: Dr. Sirlin consults, advises, and is on the speakers’ bureau for Bayer. He received grants from GE Healthcare.

The Mayo Clinic and authors JC, MY and RLE have intellectual property rights and a financial interest through receipt of royalties and equity from licensing of MRE technology. Author RLE serves as uncompensated chief executive officer of Resoundant Inc. (Rochester, MN), majority-owned by Mayo Clinic. Mayo Clinic authors have control of the data collected at Mayo. The Mayo part of research has been conducted under the oversight of, and in compliance with, the Mayo Clinic Conflict of Interest Review Board.

There are no conflicts of interest to declare for the other authors

Figures

Figure 1.
Figure 1.
Distribution of liver stiffness measurements by TE (A) and MRE (B).
Figure 2.
Figure 2.
Diagnostic accuracy of TE and MRE for diagnosing dichotomized stages of fibrosis.
Figure 3.
Figure 3.
Distribution of thresholds value for the diagnosis of dichotomized fibrosis stage of TE (A) or MRE (B). The lower line corresponds to the thresholds for a fixed sensitivity at 90%, line in the middle corresponds to the optimal threshold and the upper line corresponds to the thresholds for a fixed specificity at 90%.
Figure 4.
Figure 4.
MRE and TE images from representative patients with stage 0, 1, 2, 3, and 4 fibrosis, respectively.
See this image and copyright information in PMC

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