Korean J Radiol.  2019 Jun;20(6):880-893. 10.3348/kjr.2018.0812.

Technical Performance of Two-Dimensional Shear Wave Elastography for Measuring Liver Stiffness: A Systematic Review and Meta-Analysis

• Kim DW
• Suh CH
• Kim KW
• Pyo J
• Park C
• Jung SC

• KMID: 2447067
• DOI: http://doi.org/10.3348/kjr.2018.0812

Abstract

OBJECTIVE
To assess the technical performance of two-dimensional shear wave elastography (2D-SWE) for measuring liver stiffness.
MATERIALS AND METHODS
The Ovid-MEDLINE and EMBASE databases were searched for studies reporting the technical performance of 2D-SWE, including concerns with technical failures, unreliable measurements, interobserver reliability, and/or intraobserver reliability, published until June 30, 2018. The pooled proportion of technical failure and unreliable measurements was calculated using meta-analytic pooling via the random-effects model and inverse variance method for calculating weights. Subgroup analyses were performed to explore potential causes of heterogeneity. The pooled intraclass correlation coefficients (ICCs) for interobserver and intraobserver reliability were calculated using the Hedges-Olkin method with Fisher's Z transformation of the correlation coefficient.
RESULTS
The search yielded 34 articles. From 20 2D-SWE studies including 6196 patients, the pooled proportion of technical failure was 2.3% (95% confidence interval [CI], 1.3-3.9%). The pooled proportion of unreliable measurements from 20 studies including 6961 patients was 7.5% (95% CI, 4.7-11.7%). In the subgroup analyses, studies conducting more than three measurements showed fewer unreliable measurements than did those with three measurements or less, but no intergroup difference was found in technical failure. The pooled ICCs for interobserver reliability (from 10 studies including 517 patients) and intraobserver reliability (from 7 studies including 679 patients) were 0.87 (95% CI, 0.82-0.90) and 0.93 (95% CI, 0.89-0.95), respectively, suggesting good to excellent reliability.
CONCLUSION
2D-SWE shows good technical performance for assessing liver stiffness, with high technical success and reliability. Future studies should establish the quality criteria and optimal number of measurements.

Keyword

Elasticity imaging techniques; Liver; Meta-analysis; Ultrasonography

MeSH Terms

Elasticity Imaging Techniques*
Humans
Liver*
Methods
Population Characteristics
Ultrasonography
Weights and Measures

Figure

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  Fig. 1 Flow diagram of study selection.

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  Fig. 2 Forest plots of proportions of technical failure.CI = confidence interval, F = fixed, R = random.

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  Fig. 3 Forest plots of proportions of unreliable measurements.

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  Fig. 4 Forest plot of interobserver reliability (A) and intraobserver reliability (B).ICC = intraclass correlation coefficient

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