title: Diagnostic accuracy of real-time tissue elastography for the staging of liver fibrosis: a meta-analysis.
abstract: OBJECTIVE
  To evaluate the overall accuracy of real-time tissue elastography (RTE) for the staging of liver fibrosis.
  
  
  METHODS
  We systematically reviewed 15 studies (1,626 subjects) in which sensitivity and specificity of RTE for liver fibrosis are available. For each cut-off stage of fibrosis, i.e., F ≥ 1, F ≥ 2, F ≥ 3, and F ≥ 4, summary sensitivity and specificity were estimated using a bivariate random-effects model. Publication bias was assessed using funnel plots and Egger's test.
  
  
  RESULTS
  Summary sensitivity and specificity were 0.79 and 0.76 for F ≥ 2, 0.82 and 0.81 for F ≥ 3, and 0.74 and 0.84 for F ≥ 4, respectively. Meta-regressions revealed scoring methods of RTE and liver diseases in the samples might not influence sensitivity and specificity of RTE. However, the estimated accuracy of RTE might be overestimated due to publication bias (p = 0.004 for F ≥ 2, p < 0.001 for F ≥ 3, and p = 0.002 for F ≥ 4).
  
  
  CONCLUSIONS
  RTE is not highly accurate for any cut-off stage of fibrosis. Compared with findings of meta-analyses on Transient Elastography and Acoustic Radiation Force Impulse imaging, the overall accuracy of RTE seems to be nearly identical for the evaluation of significant liver fibrosis, but less accurate for the evaluation of cirrhosis.
  
  
  CONCLUSIONS
  • Non-invasive methods for evaluating liver fibrosis are necessary to replace liver biopsy. • ARFI is as accurate as TE for evaluating liver fibrosis. • RTE may be as accurate as TE and ARFI for fibrosis. • RTE may be less accurate than TE and ARFI for cirrhosis. • The estimated accuracy of RTE may be overestimated by publication bias.
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Aichi Medical University School of Medicine, Nagakute, Japan.
authors.forename: Kunio
authors.initials: K
authors.lastname: Kobayashi
authors.forename: Haruhisa
authors.initials: H
authors.lastname: Nakao
authors.forename: Takeshi
authors.initials: T
authors.lastname: Nishiyama
authors.forename: Yingsong
authors.initials: Y
authors.lastname: Lin
authors.forename: Shogo
authors.initials: S
authors.lastname: Kikuchi
authors.forename: Yuji
authors.initials: Y
authors.lastname: Kobayashi
authors.forename: Takaya
authors.initials: T
authors.lastname: Yamamoto
authors.forename: Norimitsu
authors.initials: N
authors.lastname: Ishii
authors.forename: Tomohiko
authors.initials: T
authors.lastname: Ohashi
authors.forename: Ken
authors.initials: K
authors.lastname: Satoh
authors.forename: Yukiomi
authors.initials: Y
authors.lastname: Nakade
authors.forename: Kiyoaki
authors.initials: K
authors.lastname: Ito
authors.forename: Masashi
authors.initials: M
authors.lastname: Yoneda
mesh_terms: D054459:Elasticity Imaging Techniques / Q000379:methods*; D006801:Humans; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging*; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D013997:Time Factors