Diagnostic accuracy of elastography and magnetic resonance imaging in patients with NAFLD: A systematic review and meta-analysis

Emmanuel Anandraj Selvaraj, Ferenc Emil Mózes, Arjun Narayan Ajmer Jayaswal, Mohammad Hadi Zafarmand, Yasaman Vali, Jenny A. Lee, Christina Kim Levick, Liam Arnold Joseph Young, Naaventhan Palaniyappan, Chang Hai Liu, Guruprasad Padur Aithal, Manuel Romero-Gómez, M. Julia Brosnan, Theresa A. Tuthill, Quentin M. Anstee, Stefan Neubauer, Stephen A. Harrison, Patrick M. Bossuyt, Michael Pavlides*, Ann DalyKatherine Johnson, Olivier Govaere, Simon Cockell, Dina Tiniakos, Pierre Bedossa, Fiona Oakley, Heather Cordell, Chris Day, Kristy Wonders, Patrick Bossuyt, Hadi Zafarmand, Jenny Lee, Vlad Ratziu, Karine Clement, Raluca Pais, Detlef Schuppan, Jörn Schattenberg, Toni Vidal-Puig, Michele Vacca, Sergio Rodrigues-Cuenca, Mike Allison, Ioannis Kamzolas, Evangelia Petsalaki, Matej Oresic, Tuulia Hyötyläinen, Aiden McGlinchey, Jose M. Mato, Oscar Millet, Fay Betsou, Estelle Sandt, LITMUS Investigators, Maria Manuela Tonini

*Corresponding author for this work

Research output: Contribution to journalArticleResearchpeer-review

148 Citations (Scopus)


Background and Aims: Vibration-controlled transient elastography (VCTE), point shear wave elastography (pSWE), 2-dimensional shear wave elastography (2DSWE), magnetic resonance elastography (MRE), and magnetic resonance imaging (MRI) have been proposed as non-invasive tests for patients with non-alcoholic fatty liver disease (NAFLD). This study evaluated their diagnostic accuracy for liver fibrosis and non-alcoholic steatohepatitis (NASH). Methods: PubMED/MEDLINE, EMBASE and the Cochrane Library were searched for studies examining the diagnostic accuracy of these index tests, against histology as the reference standard, in adult patients with NAFLD. Two authors independently screened and assessed methodological quality of studies and extracted data. Summary estimates of sensitivity, specificity and area under the curve (sAUC) were calculated for fibrosis stages and NASH, using a random effects bivariate logit-normal model. Results: We included 82 studies (14,609 patients). Meta-analysis for diagnosing fibrosis stages was possible in 53 VCTE, 11 MRE, 12 pSWE and 4 2DSWE studies, and for diagnosing NASH in 4 MRE studies. sAUC for diagnosis of significant fibrosis were: 0.83 for VCTE, 0.91 for MRE, 0.86 for pSWE and 0.75 for 2DSWE. sAUC for diagnosis of advanced fibrosis were: 0.85 for VCTE, 0.92 for MRE, 0.89 for pSWE and 0.72 for 2DSWE. sAUC for diagnosis of cirrhosis were: 0.89 for VCTE, 0.90 for MRE, 0.90 for pSWE and 0.88 for 2DSWE. MRE had sAUC of 0.83 for diagnosis of NASH. Three (4%) studies reported intention-to-diagnose analyses and 15 (18%) studies reported diagnostic accuracy against pre-specified cut-offs. Conclusions: When elastography index tests are acquired successfully, they have acceptable diagnostic accuracy for advanced fibrosis and cirrhosis. The potential clinical impact of these index tests cannot be assessed fully as intention-to-diagnose analyses and validation of pre-specified thresholds are lacking. Lay summary: Non-invasive tests that measure liver stiffness or use magnetic resonance imaging (MRI) have been suggested as alternatives to liver biopsy for assessing the severity of liver scarring (fibrosis) and fatty inflammation (steatohepatitis) in patients with non-alcoholic fatty liver disease (NAFLD). In this study, we summarise the results of previously published studies on how accurately these non-invasive tests can diagnose liver fibrosis and inflammation, using liver biopsy as the reference. We found that some techniques that measure liver stiffness had a good performance for the diagnosis of severe liver scarring.

Original languageEnglish
Pages (from-to)770-785
Number of pages16
JournalJournal of Hepatology
Issue number4
Publication statusPublished - Oct 2021


  • Biomarkers
  • Diffusion-weighted imaging
  • Iron-corrected T1
  • Liver fibrosis
  • Magnetic resonance elastography
  • Non-alcoholic fatty liver disease
  • Non-alcoholic steatohepatitis
  • Shear wave elastography
  • Transient elastography
  • deMILI
  • fibro-MRI


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