The efficiency of acoustic radiation force impulse imaging for the staging of liver fibrosis: a meta-analysis.

OBJECTIVES:

Acoustic radiation force impulse (ARFI) imaging is an ultrasound-based elastography method that is integrated into a conventional ultrasound machine. A meta-analysis based on original and abstract publications was performed to evaluate the overall performance of ARFI for the diagnosis of liver fibrosis.

METHODS:

Literature databases and conference abstracts were searched from 2007 up to February 2012. A random effects meta-analysis of the area under the receiver operating characteristic (ROC) curve (AUROC) and the diagnostic odds ratio (DOR) was performed as well as summary ROC curve techniques. Quality analyses were conducted to assess sources of heterogeneity.

RESULTS:

The systematic literature search revealed 36 studies, with 3,951 patients overall. The mean diagnostic accuracy of ARFI expressed as the AUROC was 0.84 (DOR, 11.54) for the diagnosis of significant fibrosis (F ≥ 2), 0.89 (DOR, 33.54) for the diagnosis of severe fibrosis (F ≥ 3) and 0.91 (DOR, 45.35) for the diagnosis of liver cirrhosis (F = 4). Subgroup analyses showed sources of heterogeneity between the different underlying liver diseases for F ≥ 3 and F = 4. The mean body mass index had a significant influence for F ≥ 2.

CONCLUSIONS:

The meta-analysis revealed good diagnostic accuracy of the ARFI imaging for the staging of F ≥ 2 and F ≥ 3, and excellent diagnostic accuracy for F = 4.

KEY POINTS:

• Acoustic radiation force impulse (ARFI) imaging adds important information over conventional ultrasound. • ARFI imaging provides good diagnostic performance for assessing significant/severe hepatic fibrosis. • ARFI imaging shows excellent diagnostic accuracy and odds ratio for cirrhosis staging. • Body mass index significantly influences the assessment of significant fibrosis.