Background & Aims: Metabolic dysfunction-associated steatotic liver disease (MASLD) imposes significant healthcare burdens. Early detection of advanced fibrosis and cirrhosis in MASLD is essential due to their unfavourable outcomes. This multi-level random-effects meta-analysis aimed to provide the best evidence for the diagnostic accuracy of two-dimensional shear wave elastography (2D-SWE) in detecting liver fibrosis in biopsy-proven MASLD. Approach & Results: Systematic search in PubMed/MEDLINE, Embase, Scopus, Web of Science, LILACS, and Cochrane Library electronic databases for full-text articles published in any language up to the 26th of February 2024. Included studies reported liver stiffness measurement (LSM) by 2D-SWE and used histological diagnosis as gold standard. A linear mixed-effects multiple thresholds model was employed, and summary estimates for sensitivity (Se), specificity (Sp), and summary area under the curve (sAUC) were computed. 20 observational studies (SuperSonic Imagine, General Electric Healthcare, Canon Medical Systems) fulfilled the inclusion criteria, comprising 2223 participants with biopsy-proven MASLD. The prevalence of mild fibrosis (F1), significant fibrosis (F2), advanced fibrosis (F3), and cirrhosis (F4) was 30.0%, 18.5%, 17.9%, and 10.9%, respectively. The sAUCs [95%CI] in detecting ≥F1, ≥F2, ≥F3, and F4 for all ultrasound machines considered together were 0.82 [0.16-0.98], 0.82 [0.76-0.88], 0.86 [0.77-0.93], and 0.89 [0.80-0.95], respectively. The optimal cut-off values were 6.432 kPa for ≥F1, 8.174 kPa for ≥F2, 9.418 kPa for ≥F3, and 11.548 kPa for F4, respectively. Conclusions: Our meta-analysis identified optimised cut-offs for fibrosis staging by 2D-SWE in etiology-specific chronic liver diseases (MASLD), with excellent diagnostic performance, underscoring the potential for standardising cut-off values.

中文翻译：

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2D-SWE 超声对 MASLD 肝纤维化评估的诊断准确性：多级随机效应模型荟萃分析


背景和目标：代谢功能障碍相关的脂肪性肝病（MASLD）带来了重大的医疗负担。由于 MASLD 中的晚期纤维化和肝硬化的不良结局，早期发现它们至关重要。这项多水平随机效应荟萃分析旨在为二维剪切波弹性成像 （2D-SWE） 在活检证实的 MASLD 中检测肝纤维化的诊断准确性提供最佳证据。方法和结果：在PubMed/MEDLINE、Embase、Scopus、Web of Science、LILACS和Cochrane图书馆电子数据库中系统搜索截至2024年2月26日以任何语言发表的全文文章。纳入的研究报告了通过 2D-SWE 进行肝脏硬度测量 （LSM），并使用组织学诊断作为金标准。采用线性混合效应多阈值模型，并计算敏感性 （Se） 、特异性 （Sp） 和曲线下总面积 （sAUC） 的汇总估计值。20 项观察性研究（SuperSonic Imagine、General Electric Healthcare、Canon Medical Systems）符合纳入标准，包括 2223 名经活检证实的 MALD 参与者。轻度纤维化 （F1） 、 重度纤维化 （F2） 、晚期纤维化 （F3） 和肝硬化 （F4） 的患病率分别为 30.0% 、 18.5% 、 17.9% 和 10.9%。对于一起考虑的所有超声机器，检测 ≥F1、≥F2、≥F3 和 F4 的 sAUC [95%CI] 分别为 0.82 [0.16-0.98]、0.82 [0.76-0.88]、0.86 [0.77-0.93] 和 0.89 [0.80-0.95]。最佳截断值为 ≥F1 为 6.432 kPa，≥F2 为 8.174 kPa，≥F3 为 9.418 kPa，F4 为 11.548 kPa。 结论： 我们的荟萃分析确定了病因特异性慢性肝病 （MASLD） 中 2D-SWE 纤维化分期的优化临界值，具有出色的诊断性能，强调了标准化临界值的潜力。