Supersonic shear imaging for the diagnosis of liver fibrosis and portal hypertension in liver diseases: a meta-analysis

<b>Background and aims</b>: The meta-analysis aimed to summarize the technical success rate of supersonic shear imaging (SSI) and to evaluate the diagnostic performance of liver and spleen stiffness measurement (LSM and SSM) with SSI for the detection of liver fibrosis, portal hypertension, and gastroesophageal varices in liver diseases. <b>Methods</b>: PubMed, EMBASE, and Cochrane Library databases were searched. Technical success rate of SSI was pooled. Area under curve (AUC), sensitivity, and specificity with corresponding 95% confidence interval (CI) were calculated. <b>Results</b>: Included studies regarding the diagnostic performance of SSI for liver fibrosis, portal hypertension, and esophageal varices numbered 28, 4, and 4 respectively. The pooled technical success rates of LSM and SSM were 95.3% and 75.5%, respectively. The AUC, sensitivity, and specificity of LSM/SSM for different stages of liver fibrosis were 0.85–0.94, 0.7–0.89, and 0.82–0.92, respectively. The AUC, sensitivity, and specificity of LSM were 0.84 (95%CI = 0.8–0.86), 0.79 (95%CI = 0.7–0.85), and 0.82 (95%CI = 0.72–0.88) for clinically significant portal hypertension, 0.85 (95%CI = 0.82–0.88), 0.8 (95%CI = 0.68–0.88), and 0.8 (95%CI = 0.6–0.92) for any varices, and 0.86 (95%CI = 0.83–0.89), 0.86 (95%CI = 0.76–0.92), and 0.61 (95%CI = 0.35–0.83) for high-risk varices, respectively. <b>Conclusions</b>: LSM with SSI had a high diagnostic accuracy for liver fibrosis, but a moderate diagnostic accuracy for portal hypertension and esophageal varices.

<b>背景与研究目的</b>：本项元分析旨在总结超声剪切波成像（Supersonic Shear Imaging, SSI）的技术成功率，并评估基于SSI的肝硬度测量（Liver Stiffness Measurement, LSM）与脾硬度测量（Spleen Stiffness Measurement, SSM）在肝脏疾病患者中检测肝纤维化、门静脉高压及胃食管静脉曲张的诊断效能。<b>研究方法</b>：检索PubMed、EMBASE及Cochrane Library数据库，合并分析SSI的技术成功率，计算受试者工作特征曲线下面积（Area Under Curve, AUC）、灵敏度、特异度及其对应的95%置信区间（Confidence Interval, CI）。<b>研究结果</b>：纳入评估SSI诊断肝纤维化、门静脉高压及食管静脉曲张的研究分别为28项、4项及4项。LSM与SSM的合并技术成功率分别为95.3%与75.5%。LSM/SSM针对不同分期肝纤维化的AUC、灵敏度及特异度分别为0.85~0.94、0.7~0.89及0.82~0.92。针对临床显著性门静脉高压，LSM的AUC、灵敏度及特异度分别为0.84（95%CI=0.8~0.86）、0.79（95%CI=0.7~0.85）及0.82（95%CI=0.72~0.88）；针对任意静脉曲张，分别为0.85（95%CI=0.82~0.88）、0.8（95%CI=0.68~0.88）及0.8（95%CI=0.6~0.92）；针对高危静脉曲张，分别为0.86（95%CI=0.83~0.89）、0.86（95%CI=0.76~0.92）及0.61（95%CI=0.35~0.83）。<b>研究结论</b>：基于SSI的LSM对肝纤维化具有较高的诊断准确度，而对门静脉高压与食管静脉曲张的诊断准确度处于中等水平。