title: Magnetic resonance elastography for staging liver fibrosis in non-alcoholic fatty liver disease: a diagnostic accuracy systematic review and individual participant data pooled analysis.
abstract: OBJECTIVE
  We conducted an individual participant data (IPD) pooled analysis on diagnostic accuracy of MRE to detect fibrosis stage in patients with non-alcoholic fatty liver disease (NAFLD).
  
  
  METHODS
  Through a systematic literature search, we identified studies of MRE (at 60-62.5 Hz) for staging fibrosis in patients with NAFLD, using liver biopsy as gold standard, and contacted study authors for IPD. Through pooled analysis, we calculated the cluster-adjusted AUROC, sensitivity and specificity of MRE for any (≥stage 1), significant (≥stage 2) and advanced (≥stage 3) fibrosis and cirrhosis (stage 4).
  
  
  RESULTS
  We included nine studies with 232 patients with NAFLD (mean age, 51 ± 13 years; 37.5% males; mean BMI, 33.5 ± 6.7 kg/m(2); interval between MRE and biopsy <1 year, 98.3%). Fibrosis stage distribution (stage 0/1/2/3/4) was 33.6, 32.3, 10.8, 12.9 and 10.4%, respectively. Mean AUROC (and 95% CIs) for diagnosis of any, significant or advanced fibrosis and cirrhosis was 0.86 (0.82-0.90), 0.87 (0.82-0.93), 0.90 (0.84-0.94) and 0.91 (0.76-0.95), respectively. Similar diagnostic performance was observed in stratified analysis based on sex, obesity and degree of inflammation.
  
  
  CONCLUSIONS
  MRE has high diagnostic accuracy for detection of fibrosis in NAFLD, independent of BMI and degree of inflammation.
  
  
  CONCLUSIONS
  • MRE has high diagnostic accuracy for detection of fibrosis in NAFLD. • BMI does not significantly affect accuracy of MRE in NAFLD. • Inflammation had no significant influence on MRE performance in NAFLD for fibrosis.
authors: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.
authors: Siddharth
authors: S
authors: Singh
authors: Department of Radiology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN, 55905, USA. Venkatesh.Sudhakar@mayo.edu.
authors: Sudhakar K
authors: SK
authors: Venkatesh
authors: NAFLD Translational Research Unit, Division of Gastroenterology and Hepatology, Department of Medicine, University of California, San Diego, CA, USA.
authors: Rohit
authors: R
authors: Loomba
authors: Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.
authors: Zhen
authors: Z
authors: Wang
authors: Liver Imaging Group, Department of Radiology, University of California, San Diego, CA, USA.
authors: Claude
authors: C
authors: Sirlin
authors: Department of Radiology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN, 55905, USA.
authors: Jun
authors: J
authors: Chen
authors: Department of Radiology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN, 55905, USA.
authors: Meng
authors: M
authors: Yin
authors: Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors: Frank H
authors: FH
authors: Miller
authors: Sharp and Children's MRI Center, San Diego, CA, USA.
authors: Russell N
authors: RN
authors: Low
authors: Liver Centers of Southern California, Coronado, CA, USA.
authors: Tarek
authors: T
authors: Hassanein
authors: Department of Radiology, Addenbrooke's Hospital, Cambridge, UK.
authors: Edmund M
authors: EM
authors: Godfrey
authors: Department of Radiology, Charité-Universitätsmedizin Berlin, Charité Campus Mitte, Berlin, Germany.
authors: Patrick
authors: P
authors: Asbach
authors: Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.
authors: Mohammad Hassan
authors: MH
authors: Murad
authors: Department of Radiology, Addenbrooke's Hospital, Cambridge, UK.
authors: David J
authors: DJ
authors: Lomas
authors: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.
authors: Jayant A
authors: JA
authors: Talwalkar
authors: Department of Radiology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN, 55905, USA.
authors: Richard L
authors: RL
authors: Ehman
mesh_terms: D001706:Biopsy; D054459:Elasticity Imaging Techniques / Q000379:methods* / Q000592:standards; D005260:Female; D006505:Hepatitis / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D008099:Liver / Q000473:pathology*; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease / Q000000981:diagnostic imaging*; D009765:Obesity / Q000473:pathology; D012680:Sensitivity and Specificity
keywords: Biomarker; Cirrhosis; Diagnostic performance; Elastography; Fibrosis