Performance of common imaging techniques vs serum biomarkers in assessing fibrosis in patients with chronic hepatitis B: A systematic review and meta-analysis

Table 1 Meta-analysis of hepatitis B-related significant fibrosis

	SEN (95%CI)	SPE (95%CI)	DOR (95%CI)
APRI	0.69 (0.63-0.73)	0.71 (0.66-0.75)	5 (4-6)
FIB-4	0.62 (0.57-0.67)	0.75 (0.71-0.78)	5 (4-5)
ARFI	0.77 (0.70-0.83)	0.87 (0.81-0.92)	23 (15-38)
FibroScan	0.72 (0.68-0.76)	0.82 (0.77-0.86)	12 (9-16)
MRE	0.94 (0.91-0.96)	0.96 (0.93-0.97)	348 (185-656)

SEN: Sensitivity; SPE: Specificity; DOR: Diagnostic odds ratio; CI: Confidence interval; APRI: Aminotransferase-to-platelet ratio index; FIB-4: Fibrosis index based on the 4 factors; ARFI: Acoustic radiation force impulse.

Table 2 Subgroup analysis of body mass index in prediction of significant fibrosis

Diagnostic test	BMI	Number of studies (n)	AUSROC (95%CI)	SEN (95%CI)	SPE (95%CI)
APRI	Overweight	7 (985)	0.78 (0.74-0.81)	0.78 (0.59-0.90)	0.71 (0.61-0.79)
	Normal	13 (2598)	0.75 (0.71-0.79)	0.63 (0.55-0.71)	0.77 (0.68-0.84)
	NA	27 (10142)	0.74 (0.70-0.77)	0.69 (0.62-0.74)	0.68 (0.61-0.74)
FIB-4	Overweight	5 (717)	0.76 (0.72-0.79)	0.58 (0.47-0.70)	0.80 (0.67-0.89)
	Normal	6 (1367)	0.70 (0.66-0.74)	0.58 (0.46-0.69)	0.75 (0.60-0.85)
	NA	21 (9095)	0.75 (0.71-0.79)	0.64 (0.57-0.70)	0.74 (0.69-0.78)
ARFI	Overweight	5 (679)	0.85 (0.82-0.88)	0.76 (0.64-0.85)	0.86 (0.80-0.91)
	Normala	3 (481)	0.91 (0.88-0.95)	0.84 (0.80-0.88)	0.76 (0.64-0.85)
	NAa	3 (367)	0.93 (0.85 – 0.99)	0.72 (0.63-0.80)	0.95 (0.91-0.97)
Fibroscan	Overweight	12 (1927)	0.81 (0.77-0.84)	0.68 (0.62-0.74)	0.85 (0.76-0.91)
	Normal	11 (2103)	0.83 (0.79-0.86)	0.73 (0.66-0.79)	0.82 (0.73-0.88)
	NA	6 (1005)	0.85 (0.81-0.88)	0.79 (0.69-0.87)	0.78 (0.72-0.83)

^aThe results were calculated with Meta-Disc software (v. 1.4). BMI: Body mass index; NA: Not assessable; SEN: Sensitivity; SPE: Specificity; CI: Confidence interval; AUSROC: The area under the summary receiver operating characteristic curve; APRI: Aminotransferase-to-platelet ratio index; FIB-4: Fibrosis index based on the 4 factors; ARFI: Acoustic radiation force impulse.

Table 3 Subgroup analysis of prevalence of F2 in prediction of significant fibrosis

Diagnostic test	F2%	Number of studies (n)	AUSROC (95%CI)	SEN (95%CI)	SPE (95%CI)
APRI	F2% < 50	16 (4566)	0.72 (0.68-0.76)	0.68 (0.59-0.76)	0.66 (0.57-0.75)
	F2% ≥ 50	31 (9159)	0.77 (0.73-0.81)	0.69 (0.62-0.75)	0.73 (0.68-0.78)
FIB-4	F2% < 50	9 (3234)	0.75 (0.71-0.79)	0.60 (0.47-0.72)	0.76 (0.68-0.83)
	F2% ≥ 50	23 (7945)	0.75 (0.71-0.78)	0.63 (0.57-0.68)	0.74 (0.69-0.78)
ARFI	F2% < 50	4 (554)	0.89 (0.85-0.91)	0.73 (0.62-0.82)	0.93 (0.68-0.97)
	F2% ≥ 50	7 (973)	0.88 (0.85-0.91)	0.80 (0.72-0.87)	0.82 (0.74-0.88)
Fibroscan	F2% < 50	12 (2272)	0.85 (0.81-0.88)	0.77 (0.70-0.83)	0.80 (0.71-0.86)
	F2% ≥ 50	17 (2763)	0.82 (0.78-0.85)	0.69 (0.64-0.74)	0.84 (0.78-0.88)

SEN: Sensitivity; SPE: Specificity; CI: Confidence interval; AUSROC: The area under the summary receiver operating characteristic curve; APRI: Aminotransferase-to-platelet ratio index; FIB-4: Fibrosis index based on the 4 factors; ARFI: Acoustic radiation force impulse.

Table 4 Subgroup analysis of sample size in prediction of significant fibrosis

Diagnostic test	Sample size	Number of studies (N)	AUSROC (95%CI)	SEN (95%CI)	SPE (95%CI)
APRI	n < 100	8 (588)	0.73 (0.69-0.77)	0.67 (0.60-0.74)	0.68 (0.61-0.75)
	100 ≤ n < 300	27 (5286)	0.77 (0.73-0.80)	0.69 (0.62-0.76)	0.72 (0.65-0.78)
	n ≥ 300	12 (7851)	0.73 (0.69-0.77)	0.67 (0.57-0.76)	0.69 (0.58-0.78)
FIB-4	n < 100	6 (411)	0.77 (0.73-0.80)	0.64 (0.54-0.73)	0.77 (0.67-0.85)
	100 ≤ n < 300	14 (2917)	0.76 (0.72-0.80)	0.62 (0.53-0.71)	0.77 (0.69-0.83)
	n ≥ 300	12 (7851)	0.74 (0.70-0.77)	0.62 (0.53-0.69)	0.74 (0.67-0.79)
ARFI	n < 100	2 (173)	0.72/0.75	0.83/0.50	0.65/0.90
	100 ≤ n < 300	9 (1354)	0.90 (0.87-0.92)	0.78 (0.71-0.84)	0.88 (0.82-0.93)
	n ≥ 300	0	-	-	-
Fibroscan	n < 100	6 (445)	0.80 (0.76-0.83)	0.70 (0.57-0.80)	0.76 (0.68-0.83)
	100 ≤ n < 300	20 (3659)	0.84 (0.81-0.87)	0.74 (0.69-0.79)	0.83 (0.77-0.87)
	n ≥ 300a	3 (931)	0.82 (0.69-0.95)	0.62 (0.57-0.66)	0.88 (0.84-0.90)

^a The results were calculated with Meta-Disc software (v. 1.4). SEN: Sensitivity; SPE: Specificity; CI: Confidence interval; AUSROC: The area under the summary receiver operating characteristic curve; APRI: Aminotransferase-to-platelet ratio index; FIB-4: Fibrosis index based on the 4 factors; ARFI: Acoustic radiation force impulse.