title: Acoustic Radiation Force Impulse Elastography for the Non-Invasive Evaluation of Hepatic Fibrosis in Non-Alcoholic Fatty Liver Disease Patients: A Systematic Review & Meta-Analysis.
abstract: BACKGROUND
  In order to better monitor non-alcoholic fatty liver disease (NAFLD) patients at higher risk for HCC, there is a need for non-invasive diagnostic approaches to screen for the presence of advanced fibrosis in these patients. The aim of this systematic review and meta-analysis will be to evaluate the diagnostic efficacy of ARFI elastography in detecting hepatic fibrosis in NAFLD patients.
  
  
  METHODS
  Relevant studies were identified from systematic searches of several major electronic databases (PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials). The primary outcomes were the summary sensitivity, summary specificity, the diagnostic odds ratio, and the summary receiver operating characteristic curve (SROC) of ARFI elastography in detecting significant fibrosis (defined as 4>F≥2) in NAFLD patients. Study quality was assessed using the Quality Assessment of Studies of Diagnostic Accuracy included in Systematic Review (QUADAS-2).
  
  
  RESULTS
  The summary sensitivity and specificity of ARFI in detecting significant fibrosis were 80.2% (95% confidence interval (CI): 0.758-0.842; p = 0.0000) and 85.2% (95% CI: 0.808-0.890), p = 0.1617), respectively. The pooled diagnostic odds ratio of ARFI in detecting significant fibrosis was 30.13 (95% CI: 12.08-75; chi-squared = 14.59, p = 0.0237). The area under the SROC curve (AUC) was 0.898 (standard error (SE): 0.031) with a Q* index of 0.830 (SE: 0.033).
  
  
  CONCLUSIONS
  ARFI elastography appears to be modestly accurate in detecting significant fibrosis in NAFLD patients. Future studies in this field should provide head-to-head comparisons of ARFI elastography versus other elastographic imaging modalities in NAFLD patients.
authors.affiliation: Department of Internal Medicine, Chongqing Cancer Institute, No. 181 Han Yu Road, Shapingba District, Chongqing, 400030, China.
authors.forename: Haixia
authors.initials: H
authors.lastname: Liu
authors.affiliation: Department of Ultrasonic Medicine, Chongqing Cancer Institute, No. 181 Han Yu Road, Shapingba District, Chongqing, 400030, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Fu
authors.affiliation: Department of Ultrasonic Medicine, Chongqing Cancer Institute, No. 181 Han Yu Road, Shapingba District, Chongqing, 400030, China.
authors.forename: Ruixia
authors.initials: R
authors.lastname: Hong
authors.affiliation: Department of Ultrasonic Medicine, Chongqing Cancer Institute, No. 181 Han Yu Road, Shapingba District, Chongqing, 400030, China.
authors.forename: Li
authors.initials: L
authors.lastname: Liu
authors.affiliation: Department of Ultrasonic Medicine, Chongqing Cancer Institute, No. 181 Han Yu Road, Shapingba District, Chongqing, 400030, China.
authors.forename: Fang
authors.initials: F
authors.lastname: Li
mesh_terms: D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging* / Q000209:etiology*; D008297:Male; D065626:Non-alcoholic Fatty Liver Disease / Q000150:complications* / Q000000981:diagnostic imaging*; D016017:Odds Ratio; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity