title: Diagnostic accuracy of magnetic resonance elastography in liver transplant recipients: A pooled analysis.
abstract: OBJECTIVE
  We conducted an individual participant data (IPD) pooled analysis on the diagnostic accuracy of magnetic resonance elastography (MRE) to detect fibrosis stage in liver transplant recipients.
  
  
  METHODS
  Through a systematic literature search, we identified studies on diagnostic performance of MRE for staging liver fibrosis, using liver biopsy as gold standard. We contacted study authors for published and unpublished IPD on age, sex, body mass index, liver stiffness, fibrosis stage, degree of inflammation and interval between MRE and biopsy; from these we limited analysis to patients who had undergone liver transplantation. Through pooled analysis using nonparametric two-stage receiver-operating curve (ROC) regression models, we calculated the cluster-adjusted AUROC, sensitivity and specificity of MRE for any (≥ stage 1), significant (≥ stage 2) and advanced fibrosis (≥ stage 3) and cirrhosis (stage 4).
  
  
  RESULTS
  We included 6 cohorts (4 published and 2 unpublished series) reporting on 141 liver transplant recipients (mean age, 57 years; 75.2% male; mean BMI, 27.1 kg/m2). Fibrosis stage distribution stage 0, 1, 2, 3, or 4, was 37.6%, 23.4%, 24.8%, 12% and 2.2%, respectively. Mean AUROC values (and 95% confidence intervals) for diagnosis of any (≥ stage 1), significant (≥ stage 2), or advanced fibrosis (≥ stage 3) and cirrhosis were 0.73 (0.66-0.81), 0.69 (0.62-0.74), 0.83 (0.61-0.88) and 0.96 (0.93-0.98), respectively. Similar diagnostic performance was observed in stratified analysis based on sex, obesity and inflammation grade.
  
  
  CONCLUSIONS
  In conclusion, MRE has high diagnostic accuracy for detection of advanced fibrosis and cirrhosis in liver transplant recipients, independent of BMI and degree of inflammation.
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.
authors.forename: Siddharth
authors.initials: S
authors.lastname: Singh
authors.affiliation: Department of Radiology, Mayo Clinic, Rochester, MN, USA.
authors.forename: Sudhakar K
authors.initials: SK
authors.lastname: Venkatesh
authors.affiliation: Department of Transplant Surgery, Mayo Clinic, Jacksonville, FL, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Keaveny
authors.affiliation: Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: Sharon
authors.initials: S
authors.lastname: Adam
authors.affiliation: Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: Frank H
authors.initials: FH
authors.lastname: Miller
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, U.K.
authors.forename: Edmund M
authors.initials: EM
authors.lastname: Godfrey
authors.affiliation: Department of Radiology, Mayo Clinic, Scottsdale, AZ, USA.
authors.forename: Alvin C
authors.initials: AC
authors.lastname: Silva
authors.affiliation: Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.
authors.forename: Zhen
authors.initials: Z
authors.lastname: Wang
authors.affiliation: Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.
authors.forename: Mohammad Hassan
authors.initials: MH
authors.lastname: Murad
authors.affiliation: Division of Hepatology, Baylor University Medical Center, Dallas, TX, USA.
authors.forename: Sumeet K
authors.initials: SK
authors.lastname: Asrani
authors.affiliation: Department of Radiology, Addenbrooke's Hospital, Cambridge, U.K.
authors.forename: David J
authors.initials: DJ
authors.lastname: Lomas
authors.affiliation: Department of Radiology, Mayo Clinic, Rochester, MN, USA.
authors.forename: Richard L
authors.initials: RL
authors.lastname: Ehman
mesh_terms: D019540:Area Under Curve; D001706:Biopsy; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D005355:Fibrosis / Q000000981:diagnostic imaging* / Q000209:etiology; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012372:ROC Curve; D015203:Reproducibility of Results; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome