Comparison of the diagnostic accuracy of shear wave elastography with transient elastography in adult nonalcoholic fatty liver disease: a systematic review and network meta-analysis of diagnostic test accuracy

To compare the diagnostic test accuracy (DTA) of shear wave elastography (SWE) to that of transient elastography (TE) for liver fibrosis grade assessment in nonalcoholic fatty liver disease adults.

MEDLINE, The Cochrane Library, and Web of Science were searched. Inclusion criteria were primary studies examining DTA of TE, point SWE (pSWE), two-dimensional SWE (2D-SWE), or magnetic resonance elastography (MRE) with liver biopsy. Network meta-analysis was conducted using a Bayesian bivariate mixed-effects model.

For fibrosis grade 2 or higher, 15 studies with 25 observations (16 observations for TE, 1 for MRE, 4 for pSWE and 2D-SWE; 2,066 patients) were included; the pooled sensitivity and specificity were 0.79 (95% credible interval (CrI) 0.70–0.86; 95% prediction interval (PI) 0.36–0.96) and 0.73 (95% CrI 0.62–0.82; 95% PI 0.23–0.96) for TE, 0.68 (95% CrI 0.48–0.83; 95% PI 0.23–0.94) and 0.75 (95% CrI 0.53–0.88; 95% PI 0.24–0.97) for pSWE, 0.85 (95% CrI 0.70–0.93; 95% PI 0.40–0.98) and 0.72 (95% CrI 0.49–0.86; 95% PI 0.20–0.96) for 2D-SWE, respectively. The proportion of studies classified as unclear in QUADAS-2 was high, and the results were heterogeneous.

2D-SWE could be recommended as TE is for liver fibrosis assessment.

The protocol of this systematic review and network meta-analysis has been registered in PROSPERO (CRD42022327249). All included primary papers have already been published and the information and data can be used freely.