The diagnostic performance of shear-wave elastography for liver fibrosis in children and adolescents: A systematic review and diagnostic meta-analysis

To assess the diagnostic performance of shear-wave elastography for determining the severity of liver fibrosis in children and adolescents. An electronic literature search of PubMed and EMBASE was conducted. Bivariate modelling and hierarchical summary receiver-operating-characteristic modelling were performed to evaluate the diagnostic performance of shear-wave elastography. Meta-regression and subgroup analyses according to the modality of shear-wave imaging and the degree of liver fibrosis were also performed. Twelve eligible studies with 550 patients were included. Shear-wave elastography showed a summary sensitivity of 81 % (95 % CI: 71-88) and a specificity of 91 % (95 % CI: 83-96) for the prediction of significant liver fibrosis. The number of measurements of shear-wave elastography performed was a significant factor influencing study heterogeneity. Subgroup analysis revealed shear-wave elastography to have an excellent diagnostic performance according to each degree of liver fibrosis. Supersonic shear imaging (SSI) had a higher sensitivity (p <.01) and specificity (p <.01) than acoustic radiation force impulse imaging (ARFI). Shear-wave elastography is an excellent modality for the evaluation of the severity of liver fibrosis in children and adolescents. Compared with ARFI, SSI showed better diagnostic performance for prediction of significant liver fibrosis.