Diagnostic Accuracy of Real-Time Tissue Elastography for the Staging of Liver Fibrosis: A Meta-Analysis

Objective To evaluate the overall accuracy of real-time tissue elastography (RTE) for the staging of liver fibrosis. Methods We systematically reviewed 15 studies (1,626 subjects) in which sensitivity and specificity of RTE for liver fibrosis are available. For each cut-off stage of fibrosis, i.e., F >= 1, F >= 2, F >= 3, and F >= 4, summary sensitivity and specificity were estimated using a bivariate random-effects model. Publication bias was assessed using funnel plots and Egger's test. Results Summary sensitivity and specificity were 0.79 and 0.76 for F >= 2, 0.82 and 0.81 for F >= 3, and 0.74 and 0.84 for F >= 4, respectively. Meta-regressions revealed scoring methods of RTE and liver diseases in the samples might not influence sensitivity and specificity of RTE. However, the estimated accuracy of RTE might be overestimated due to publication bias (p=0.004 for F >= 2, p< 0.001 for F >= 3, and p=0.002 for F >= 4). Conclusions RTE is not highly accurate for any cut-off stage of fibrosis. Compared with findings of meta-analyses on Transient Elastography and Acoustic Radiation Force Impulse imaging, the overall accuracy of RTE seems to be nearly identical for the evaluation of significant liver fibrosis, but less accurate for the evaluation of cirrhosis.