Diagnostic performance of elastography on liver fibrosis in antiviral treatment-naive chronic hepatitis B patients: a meta-analysis

Background This study aimed to assess the performance of transient elastography (TE), two-dimensional shear wave elastography (2D-SWE), and magnetic resonance elastography (MRE) for staging significant fibrosis and cirrhosis in untreated chronic hepatitis B (CHB) patients. Methods Pubmed, Embase, Web of Science, and Cochrane Library were searched for terms involving CHB, TE, 2D-SWE, and MRE. Other etiologies of chronic liver disease, previous treatment in patients, or articles not published in SCI journals were excluded. Hierarchical non-linear models were used to evaluate the diagnostic accuracy of TE, 2D-SWE, and MRE. Heterogeneity was explored via analysis of threshold effect and meta-regression. Results Twenty-eight articles with a total of 4,540 untreated CHB patients were included. The summary areas under the receiver-operating characteristic curves (AUROCs) using TE, 2D-SWE, and MRE for predicting significant fibrosis (SF) were 0.84, 0.89, and 0.99, respectively. The AUROC values of TE, 2D-SWE, and MRE for staging cirrhosis were 0.9, 0.94, and 0.99, respectively. Based on the meta-analysis of studies with head-to-head comparison, 2D-SWE is superior to TE (0.92 vs 0.85, P < 0.01) in staging significant fibrosis. Conclusion TE, 2D-SWE, and MRE express acceptable diagnostic accuracies in staging significant fibrosis and cirrhosis in untreated CHB patients. 2D-SWE outperforms TE in detecting significant fibrosis in treatment-naive people with hepatitis B virus.