Magnetic resonance elastography had significantly higher diagnostic accuracy in staging fibrosis compared with transient elastography among patients with biopsy-proven nonalcoholic fatty liver disease, according to a recently published study.
“These results have important implications in developing an optimal approach for noninvasive assessment of the severity of NAFLD,” Cynthia Hsu, MD, from the University of California, San Diego, and colleagues wrote. “Depending on the desirability of accuracy, the need to identify all the individuals or only individuals with a specific disease stage and availability of these two noninvasive modalities, this study provides much needed information that will help define the optimal strategies for the management of NAFLD patients.”
Hsu and colleagues compared the diagnostic accuracies of MRE and TE using data from three studies with a total of 230 patients. The studies had a low risk for bias and a Quality Assessment of Diagnostic Accuracy Studies score of 12 or higher.
The AUROC of TE compared with MRE for detection of fibrosis stages 1 or higher was 0.82 (95% CI, 0.76-0.88) vs. 0.87 (95% CI, 0.82-0.91); for stage 2 or higher it was 0.87 (95% CI, 0.82-0.91) vs. 0.92 (95% CI, 0.88-0.96); for stage 3 or higher it was 0.84 (95% CI, 0.78-0.9) vs. 0.93 (95% CI, 0.89-0.96); and for stage 4 it was 0.84 (95% CI, 0.73-0.94) vs. 0.94 (95% CI, 0.89-0.99).
MRE remained superior to vibration controlled TE after multivariate analysis for stage 1 (P = .0334), stage 2 (P = .0182), stage 3 (P = .0029) and stage 4 (P = .0137).
“Depending on the context of use, MRE and TE can be used either to rule in or rule out the stage of fibrosis,” Hsu and colleagues wrote.
While the negative predictive values were similarly high between MRE (95.8%) and TE (94.3%), positive predictive values were low for both MRE (70.3%) and TE (65.4%), representing a low performance threshold for ruling in the presence of advanced fibrosis.
“In situations where accurate staging of fibrosis is important, MRE may be preferable to TE due to the higher accuracy of MRE, whereas TE may be preferable in routine clinical care to rule out or rule in advanced fibrosis depending on the risk or the population screened,” the researchers wrote. “However, further cost-effectiveness studies are needed to draw more definite conclusions.” – by Talitha Bennett
Disclosure: Hsu reports no relevant financial disclosures. Please see the full study for the other authors' relevant financial disclosures.