Published online Aug 6, 2019. doi: 10.12998/wjcc.v7.i15.2022
Peer-review started: March 4, 2019
First decision: May 31, 2019
Revised: June 25, 2019
Accepted: July 3, 2019
Article in press: July 3, 2019
Published online: August 6, 2019
Noninvasive biomarkers have been developed to predict hepatitis B virus (HBV) related fibrosis owing to the significant limitations of liver biopsy. Both serum biomarkers and imaging techniques have shown promising results and may improve the evaluation of liver fibrosis. However, most of the previous studies focused on the diagnostic effects of various imaging techniques on fibrosis in all chronic liver diseases.
To compare the performance of common imaging methods and serum biomarkers for prediction of significant fibrosis caused only by HBV infection.
A systematic review was conducted on the records available in PubMed, EMBASE, and the Cochrane Library electronic databases until December 2018. We systematically assessed the effectiveness of two serum biomarkers and three imagine techniques in predicting significant fibrosis solely caused by HBV infection. The serum biomarkers included aspartate aminotransferase-to-platelet ratio index (APRI) and fibrosis index based on the 4 factors (FIB-4). The three imaging techniques included acoustic radiation force impulse (ARFI), FibroScan, and magnetic resonance elastography (MRE). Three parameters, the area under the summary receiver operating characteristic curve (AUSROC), the summary diagnostic odds ratio, and the summary sensitivity and specificity, were used to examine the accuracy of all tests for liver fibrosis.
Out of 2831 articles evaluated for eligibility, 204 satisfied the predetermined inclusion criteria for this current meta-analysis. Eventually, our final data contained 81 studies. The AUSROCs of serum biomarkers of APRI and FIB-4 were both 0.75. For imaging techniques (ARFI, FibroScan, and MRE), the areas were 0.89, 0.83, and 0.97, respectively. The heterogeneities of ARFI and FibroScan were statistically significant (I2 > 50%). The publication bias was not observed in any of the serum biomarkers or imaging methods.
These five methods have attained an acceptable level of diagnostic accuracy. Imaging techniques, MRE in particular, demonstrate significant advantages in accurately predicting HBV-related significant fibrosis, while serum biomarkers are admissible methods.
Core tip: Many researchers compared the diagnostic effects for liver fibrosis by new techniques within the domain of imaging techniques separately or focused on fibrosis in all chronic liver diseases. We perform a meta-analysis to compare the effectiveness of both some common imaging methods and serum biomarkers for prediction of significant fibrosis among hepatitis B virus (HBV)-monoinfected patients. The results reveal that imaging techniques have significant advantages in prediction of HBV-related significant fibrosis.