Page 12 - NON-INVASIVE TESTS FOR EVALUATION OF LIVER DISEASE SEVERITY AND PROGNOSIS
P. 12
JOURNAL OF HEPATOLOGY
Table 7. Diagnostic performance of pSWE using ARFI for F P2 and F4 in chronic liver diseases.
Authors Etiologies Year Patients F≥2 F4 Cut-offs AUROC Se Sp CC
(n) (%) (%) (m/s) (%) (%) (%)
Fierbinteanu-Braticevici et al. [166] HCV 2009 100 87 1.22 0.91 100 71 96
27 1.94 0.99 100 98 99
Friedrich-Rust et al. [167] HCV, HBV 2009 106 59 1.37 0.82 69 92 78
10 1.75 0.91 83 90 91
Lupsor et al. [168] HCV 2009 112 59 1.34 0.86 68 93 78
38 2.11 0.94 80 95 89
Goertz et al. [169] HCV, HBV 2010 79 39 1.24 0.85 86 70 76
16 1.73 0.87 100 78 82
Takahashi et al. [170] Mixed 2010 80 64 1.34 0.94 91 80 87
31 1.81 0.96 94 87 89
Palmeri et al. [186] NAFLD 2011 172 30* 4.24** 0.91 90 90 90
Piscaglia et al. [171] Mixed 2011 122 64 1.63 0.79 59 100 74
39 1.87 0.91 81 91 87
Rizzo et al. [172] HCV 2011 146 63 1.31 0.86 81 70 77
22 2.11 0.89 83 86 85
Rifai et al. [173] Mixed 2011 122 n.a. 1.60 0.82 80 92 n.a.
Sporea et al. [174] Mixed 2011 114 61 1.27 0.89 89 68 81
31 1.71 0.93 93 87 89
Sporea et al. [175] Mixed 2011 223 52 1.41 0.77 71 78 74
2 1.82 0.92 100 88 88
Toshima et al. [176] Mixed 2011 103 66 1.52 0.81 75 76 75
27 1.79 0.87 86 79 81
Colombo et al. [177] Mixed 2012 91 35 1.44 0.81 84 70 75
14 1.71 0.93 100 77 80
Friedrich-Rust et al. [180] HBV 2013 131 24 1.39 0.73 50 90 80
HCV, chronic hepatitis C; HBV, chronic hepatitis B; NAFLD, non-alcoholic fatty liver disease; AUROC, area under ROC curve; Se, sensitivity; Sp, specificity; CC, correctly
classified: true positive and negative; n.a., not available.
⁄F3–F4.
⁄⁄Transformed in kPa.
Transient elastography vs. other techniques chronic liver disease) suggested that MR elastography might be
Studies comparing TE and pSWE using ARFI show varying results. more accurate than TE in diagnosis of significant fibrosis whereas
While many studies reported comparable results for both meth- another study from the Netherlands [194] in 85 patients with
ods [167,174,179,191,192], some studies report better results for viral hepatitis reported similar accuracy for significant fibrosis.
ARFI [172] and others better results for TE [168,174], respec- Further data are required to evaluate if MR elastography has
tively. In a recent meta-analysis [90] including 13 studies superior accuracy for detecting significant fibrosis and cirrhosis
(n = 1163 patients) comparing pSWE using ARFI with TE (11 as compared to TE, pSWE/ARFI, or 2D-SWE.
full-length articles and two abstracts), no significant difference
in DOR were found between ARFI and TE. Summary sensitivities Recommendations
and specificities for the diagnosis of significant fibrosis were
0.74 and 0.83 for ARFI and 0.78 and 0.84 for TE, respectively • pSWE/ARFI performs better for detecting cirrhosis than
and 0.87 and 0.87 for ARFI and 0.89 and 0.87 for TE for the significant fibrosis and is better validated in chronic
diagnosis of cirrhosis, respectively. hepatitis C than for hepatitis B, HIV-HCV coinfection,
NAFLD and other liver diseases (A1)
2D-SWE has been compared to TE in only three studies
[97,100,189]. In chronic hepatitis C [189], AUROCs of SWE were • pSWE/ARFI shows equivalent performance to TE for
significantly higher than with TE for the diagnosis of significant detecting significant fibrosis and cirrhosis (A1)
fibrosis (0.92 vs. 0.84, respectively; p = 0.002) but not for cirrhosis
(0.98 vs. 0.96, p = 0.48). In chronic hepatitis B, AUROCs for SWE • 2D-SWE is a promising technique that is currently
were significantly higher for both significant fibrosis (0.88 vs. under investigation. It seems to be at least equivalent
0.78) and cirrhosis (0.98 vs. 0.92) [97]. In 349 patients with to TE and pSWE/ARFI for non-invasive staging of liver
chronic liver disease [100], SWE had a higher accuracy than TE fibrosis in viral hepatitis (B1)
for the diagnosis of severe fibrosis (PF3) (p = 0.0016), and a
higher accuracy than pSWE using ARFI for the diagnosis of signifi- • Comparison between MR elastography and TE has
cant fibrosis (PF2) (p = 0.0003). provided conflicting results. Further data are needed
(A1)
MR elastography has been compared to TE in patients with
chronic liver diseases in three studies with conflicting results
[193–195]. Two studies (a pilot Belgian study [193] and a
Japanese retrospective study [195] in 96 and 113 patients with
Journal of Hepatology 2015 vol. xxx j xxx–xxx 11
Please cite this article in press as: EASL-ALEH Clinical Practice Guidelines: Non-invasive tests for evaluation of liver disease severity and prognosis. J
Hepatol (2015), http://dx.doi.org/10.1016/j.jhep.2015.04.006
Table 7. Diagnostic performance of pSWE using ARFI for F P2 and F4 in chronic liver diseases.
Authors Etiologies Year Patients F≥2 F4 Cut-offs AUROC Se Sp CC
(n) (%) (%) (m/s) (%) (%) (%)
Fierbinteanu-Braticevici et al. [166] HCV 2009 100 87 1.22 0.91 100 71 96
27 1.94 0.99 100 98 99
Friedrich-Rust et al. [167] HCV, HBV 2009 106 59 1.37 0.82 69 92 78
10 1.75 0.91 83 90 91
Lupsor et al. [168] HCV 2009 112 59 1.34 0.86 68 93 78
38 2.11 0.94 80 95 89
Goertz et al. [169] HCV, HBV 2010 79 39 1.24 0.85 86 70 76
16 1.73 0.87 100 78 82
Takahashi et al. [170] Mixed 2010 80 64 1.34 0.94 91 80 87
31 1.81 0.96 94 87 89
Palmeri et al. [186] NAFLD 2011 172 30* 4.24** 0.91 90 90 90
Piscaglia et al. [171] Mixed 2011 122 64 1.63 0.79 59 100 74
39 1.87 0.91 81 91 87
Rizzo et al. [172] HCV 2011 146 63 1.31 0.86 81 70 77
22 2.11 0.89 83 86 85
Rifai et al. [173] Mixed 2011 122 n.a. 1.60 0.82 80 92 n.a.
Sporea et al. [174] Mixed 2011 114 61 1.27 0.89 89 68 81
31 1.71 0.93 93 87 89
Sporea et al. [175] Mixed 2011 223 52 1.41 0.77 71 78 74
2 1.82 0.92 100 88 88
Toshima et al. [176] Mixed 2011 103 66 1.52 0.81 75 76 75
27 1.79 0.87 86 79 81
Colombo et al. [177] Mixed 2012 91 35 1.44 0.81 84 70 75
14 1.71 0.93 100 77 80
Friedrich-Rust et al. [180] HBV 2013 131 24 1.39 0.73 50 90 80
HCV, chronic hepatitis C; HBV, chronic hepatitis B; NAFLD, non-alcoholic fatty liver disease; AUROC, area under ROC curve; Se, sensitivity; Sp, specificity; CC, correctly
classified: true positive and negative; n.a., not available.
⁄F3–F4.
⁄⁄Transformed in kPa.
Transient elastography vs. other techniques chronic liver disease) suggested that MR elastography might be
Studies comparing TE and pSWE using ARFI show varying results. more accurate than TE in diagnosis of significant fibrosis whereas
While many studies reported comparable results for both meth- another study from the Netherlands [194] in 85 patients with
ods [167,174,179,191,192], some studies report better results for viral hepatitis reported similar accuracy for significant fibrosis.
ARFI [172] and others better results for TE [168,174], respec- Further data are required to evaluate if MR elastography has
tively. In a recent meta-analysis [90] including 13 studies superior accuracy for detecting significant fibrosis and cirrhosis
(n = 1163 patients) comparing pSWE using ARFI with TE (11 as compared to TE, pSWE/ARFI, or 2D-SWE.
full-length articles and two abstracts), no significant difference
in DOR were found between ARFI and TE. Summary sensitivities Recommendations
and specificities for the diagnosis of significant fibrosis were
0.74 and 0.83 for ARFI and 0.78 and 0.84 for TE, respectively • pSWE/ARFI performs better for detecting cirrhosis than
and 0.87 and 0.87 for ARFI and 0.89 and 0.87 for TE for the significant fibrosis and is better validated in chronic
diagnosis of cirrhosis, respectively. hepatitis C than for hepatitis B, HIV-HCV coinfection,
NAFLD and other liver diseases (A1)
2D-SWE has been compared to TE in only three studies
[97,100,189]. In chronic hepatitis C [189], AUROCs of SWE were • pSWE/ARFI shows equivalent performance to TE for
significantly higher than with TE for the diagnosis of significant detecting significant fibrosis and cirrhosis (A1)
fibrosis (0.92 vs. 0.84, respectively; p = 0.002) but not for cirrhosis
(0.98 vs. 0.96, p = 0.48). In chronic hepatitis B, AUROCs for SWE • 2D-SWE is a promising technique that is currently
were significantly higher for both significant fibrosis (0.88 vs. under investigation. It seems to be at least equivalent
0.78) and cirrhosis (0.98 vs. 0.92) [97]. In 349 patients with to TE and pSWE/ARFI for non-invasive staging of liver
chronic liver disease [100], SWE had a higher accuracy than TE fibrosis in viral hepatitis (B1)
for the diagnosis of severe fibrosis (PF3) (p = 0.0016), and a
higher accuracy than pSWE using ARFI for the diagnosis of signifi- • Comparison between MR elastography and TE has
cant fibrosis (PF2) (p = 0.0003). provided conflicting results. Further data are needed
(A1)
MR elastography has been compared to TE in patients with
chronic liver diseases in three studies with conflicting results
[193–195]. Two studies (a pilot Belgian study [193] and a
Japanese retrospective study [195] in 96 and 113 patients with
Journal of Hepatology 2015 vol. xxx j xxx–xxx 11
Please cite this article in press as: EASL-ALEH Clinical Practice Guidelines: Non-invasive tests for evaluation of liver disease severity and prognosis. J
Hepatol (2015), http://dx.doi.org/10.1016/j.jhep.2015.04.006
