title: Diagnostic performance of magnetic resonance elastography in staging liver fibrosis: a systematic review and meta-analysis of individual participant data.
abstract: OBJECTIVE
  Magnetic resonance elastography (MRE) is a noninvasive tool for staging liver fibrosis. We conducted a meta-analysis of individual participant data collected from published studies to assess the diagnostic accuracy of MRE for staging liver fibrosis in patients with chronic liver diseases (CLD).
  
  
  METHODS
  Through a systematic literature search of multiple databases (2003-2013), we identified studies on diagnostic performance of MRE for staging liver fibrosis in patients with CLD with native anatomy, using liver biopsy as the standard. We contacted study authors to collect data on each participant's age, sex, body mass index (BMI), liver stiffness (measured by MRE), fibrosis stage, staging system used, degree of inflammation, etiology of CLD, and interval between MRE and biopsy. Through a pooled analysis, we calculated cluster-adjusted area under the receiver-operating curve, sensitivity, and specificity of MRE for any fibrosis (≥stage 1), significant fibrosis (≥stage 2), advanced fibrosis (≥stage 3), and cirrhosis (stage 4).
  
  
  RESULTS
  We analyzed data from 12 retrospective studies, comprising 697 patients (mean age, 55 ± 13 y; 59.4% male; mean BMI, 26.9 ± 6.7 kg/m(2); 92.1% with <1 year interval between MRE and biopsy; and 47.1% with hepatitis C). Overall, 19.5%, 19.4%, 15.5%, 15.9%, and 29.7% patients had stage 0, 1, 2, 3, and 4 fibrosis, respectively. The mean area under the receiver-operating curve values (and 95% confidence intervals) for the diagnosis of any (≥stage 1), significant (≥stage 2), advanced fibrosis (≥stage 3), and cirrhosis, were as follows: 0.84 (0.76-0.92), 0.88 (0.84-0.91), 0.93 (0.90-0.95), and 0.92 (0.90-0.94), respectively. A similar diagnostic performance was observed in stratified analysis based on sex, obesity, and etiology of CLD. The overall rate of failure of MRE was 4.3%.
  
  
  CONCLUSIONS
  Based on a pooled analysis of data from individual participants, MRE has a high accuracy for the diagnosis of significant or advanced fibrosis and cirrhosis, independent of BMI and etiology of CLD. Prospective studies are warranted to better understand the diagnostic performance of MRE.
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Siddharth
authors.initials: S
authors.lastname: Singh
authors.affiliation: Department of Radiology, Mayo Clinic, Rochester, Minnesota. Electronic address: venkatesh.sudhakar@mayo.edu.
authors.forename: Sudhakar K
authors.initials: SK
authors.lastname: Venkatesh
authors.affiliation: Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota.
authors.forename: Zhen
authors.initials: Z
authors.lastname: Wang
authors.affiliation: Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Frank H
authors.initials: FH
authors.lastname: Miller
authors.affiliation: Department of Radiology, University of Yamanashi, Chuo-shi, Yamanashi, Japan.
authors.forename: Utaroh
authors.initials: U
authors.lastname: Motosugi
authors.affiliation: Sharp and Children's Magnetic Resonance Imaging Center, San Diego, California.
authors.forename: Russell N
authors.initials: RN
authors.lastname: Low
authors.affiliation: Liver Centers of Southern California, Coronado, California.
authors.forename: Tarek
authors.initials: T
authors.lastname: Hassanein
authors.affiliation: Department of Radiology, Charité-Universitätsmedizin Berlin, Charité Campus Mitte, Berlin, Germany.
authors.forename: Patrick
authors.initials: P
authors.lastname: Asbach
authors.affiliation: Department of Radiology, Addenbrooke's Hospital, Cambridge, United Kingdom.
authors.forename: Edmund M
authors.initials: EM
authors.lastname: Godfrey
authors.affiliation: Department of Radiology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Meng
authors.initials: M
authors.lastname: Yin
authors.affiliation: Department of Radiology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Jun
authors.initials: J
authors.lastname: Chen
authors.affiliation: Department of Transplant, Mayo Clinic, Jacksonville, Florida.
authors.forename: Andrew P
authors.initials: AP
authors.lastname: Keaveny
authors.affiliation: Department of Radiology, Department of Medicine, Mayo Clinic, Jacksonville, Florida.
authors.forename: Mellena
authors.initials: M
authors.lastname: Bridges
authors.affiliation: Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Anneloes
authors.initials: A
authors.lastname: Bohte
authors.affiliation: Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota.
authors.forename: Mohammad Hassan
authors.initials: MH
authors.lastname: Murad
authors.affiliation: Department of Radiology, Addenbrooke's Hospital, Cambridge, United Kingdom.
authors.forename: David J
authors.initials: DJ
authors.lastname: Lomas
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Jayant A
authors.initials: JA
authors.lastname: Talwalkar
authors.affiliation: Department of Radiology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Richard L
authors.initials: RL
authors.lastname: Ehman
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D006651:Histocytochemistry; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging* / Q000473:pathology*; D008103:Liver Cirrhosis / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D012680:Sensitivity and Specificity
keywords: Diagnostic Performance; Elastography; IPD; Noninvasive; Pooled Analysis