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Service Line: Rapid Response Service
Version: 1.0
Publication Date: August 08, 2017
Report Length: 12 Pages
CADTH RAPID RESPONSE REPORT: REFERENCE LIST
Non-Invasive Imaging
Modalities for the Diagnosis
and Monitoring of Liver
Fibrosis: Diagnostic
Accuracy, Clinical
Effectiveness/Utility, Cost-
Effectiveness, and Guidelines
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REFERENCE LIST Non-Invasive Imaging Modalities for the Diagnosis and Monitoring of Liver Fibrosis 2
Authors: Charlotte Wells, Kelly Farrah
Cite As: Non-invasive imaging modalities for the diagnosis and monitoring of liver fibrosis: diagnostic accuracy, clinical effectiveness/utility, cost-effectiveness,
and guidelines. Ottawa: CADTH; 2017 Aug. (CADTH rapid response report: reference list).
Acknowledgments:
Disclaimer: The information in this document is intended to help Canadian health care decision-makers, health care professionals, health systems leaders,
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While care has been taken to ensure that the information prepared by CADTH in this document is accurate, complete, and up-to-date as at the applicable date
the material was first published by CADTH, CADTH does not make any guarantees to that effect. CADTH does not guarantee and is not responsible for the
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About CADTH: CADTH is an independent, not-for-profit organization responsible for providing Canada’s health care decision-makers with objective evidence
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Funding: CADTH receives funding from Canada’s federal, provincial, and territorial governments, with the exception of Quebec.
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REFERENCE LIST Non-Invasive Imaging Modalities for the Diagnosis and Monitoring of Liver Fibrosis 3
Research Questions
1. What is the diagnostic accuracy of non-invasive imaging modalities to detect liver
fibrosis in patients with or suspected of having liver disease?
2. What is the clinical effectiveness and clinical utility of non-invasive imaging modalities to
detect liver fibrosis in patients with or suspected of having liver disease?
3. What is the cost-effectiveness of non-invasive imaging modalities to detect liver fibrosis
in patients with or suspected of having liver disease?
4. What are the evidence-based guidelines associated with the use of non-invasive
imaging modalities to detect liver fibrosis in patients with or suspected of having liver
disease?
Key Findings
Four health technology assessments, 30 systematic reviews (21 with meta-analyses), and
four economic evaluations were identified regarding the use of non-invasive imaging
modalities to detect liver fibrosis in patients with or suspected of having liver disease.
Additionally, ten evidence-based guidelines were identified.
Methods
A limited literature search was conducted on key resources including PubMed, The
Cochrane Library, University of York Centre for Reviews and Dissemination (CRD)
databases, Canadian and major international health technology agencies, as well as a
focused Internet search. Methodological filters were applied to limit retrieval to health
technology assessments, systematic reviews, meta-analyses, randomized controlled trials,
economic studies, and guidelines. The search was also limited to English language
documents published between January 1, 2012 and July 31, 2017. Internet links were
provided, where available.
Selection Criteria
One reviewer screened citations and selected studies based on the inclusion criteria
presented in Table 1.
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REFERENCE LIST Non-Invasive Imaging Modalities for the Diagnosis and Monitoring of Liver Fibrosis 4
Table 1: Selection Criteria
Population Adult and pediatric patients with liver disease or suspected of having liver disease with accompanying liver fibrosis (e.g., but not limited to, chronic viral hepatitis, non-alcoholic fatty liver disease, alcoholic liver disease, liver malignancies, etc.)
Intervention Imaging modalities (e.g., but not limited to, transient elastography [Fibroscan], magnetic resonance imaging [MRI], computed tomography [CT], etc.)
Comparator Q1-3: Liver biopsy; Sham; No treatment Q4: No comparator
Outcomes Q1: Diagnostic accuracy (in diagnosing/detecting fibrosis or staging/grading disease/fibrosis severity, validity, reliability, sensitivity, specificity) Q2: Clinical effectiveness and utility (e.g., monitoring of liver disease/fibrosis once treatment is initiated, use to make treatment decisions); Safety (e.g., false positives/false negatives, harms to the patient) Q3: Cost-effectiveness (e.g., incremental cost per QALY or health benefit gained) Q4: Guidelines (for both diagnosis and monitoring)
Study Designs Health technology assessment, systematic reviews, meta-analyses, randomized controlled trials, economic evaluations, evidence-based guidelines
Results
Rapid Response reports are organized so that the higher quality evidence is presented first.
Therefore, health technology assessment reports, systematic reviews, and meta-analyses
are presented first. These are followed by randomized controlled trials, economic
evaluations, and evidence-based guidelines.
Four health technology assessments, 30 systematic reviews (21 with meta-analyses), and
four economic evaluations were identified regarding the use of non-invasive imaging
modalities to detect liver fibrosis in patients with or suspected of having liver disease. No
randomized-controlled trials were identified. Additionally, ten evidence-based guidelines
were identified associated with the use of non-invasive imaging modalities to detect liver
fibrosis in patients with or suspected of having liver disease.
Additional references of potential interest are provided in the appendix.
Health Technology Assessments
1. Summers JA, Radhakrishnan M, Morris E, Chalkidou A, Rua T, Patel A, et al. Virtual
touch quantification to diagnose and monitor liver fibrosis in hepatitis B and hepatitis C:
a NICE medical technology guidance. Appl Health Econ Health Policy [Internet]. 2017
Apr [cited 2017 Aug 4];15(2):139-54. Available from:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5343083
PubMed: PM27601240
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5343083http://www.ncbi.nlm.nih.gov/pubmed/27601240
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REFERENCE LIST Non-Invasive Imaging Modalities for the Diagnosis and Monitoring of Liver Fibrosis 5
2. Steadman R, Myers RP, Leggett L, Lorenzetti D, Noseworthy T, Rose S, et al. A health
technology assessment of transient elastography in adult liver disease. Can J
Gastroenterol [Internet]. 2013 Mar [cited 2017 Aug 4];27(3):149-58. Available from:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3732152
PubMed: PM23516679
3. Steadman R, Leggett L, Lorenzetti D, Noseworthy T, Rose S, Sutherland L, et al. A
health technology assessment of transient elastography in liver disease [Internet].
Calgary: University of Calgary, Health Technology Assessment Unit; 2012 [cited 2017
Aug 4]. http://www.health.alberta.ca/documents/AHTDP-ETG-UofC-STE.pdf
4. Stevenson M, Lloyd-Jones M, Morgan MY, Wong R. Non-invasive diagnostic
assessment tools for the detection of liver fibrosis in patients with suspected alcohol-
related liver disease: a systematic review and economic evaluation. Health Technol
Assess [Internet]. 2012 [cited 2017 Aug 4];16(4):1-174. Available from:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4781535
PubMed: PM22333291
Systematic Reviews and Meta-analyses
Adult Populations
5. Herrmann E, de Lédinghen, V, Cassinotto C, Chu WC, Leung VY, Ferraioli G, et al.
Assessment of biopsy-proven liver fibrosis by 2D-shear wave elastography: An
individual patient data based meta-analysis. Hepatology. 2017 Mar 31. [Epub ahead of
print]
PubMed: PM28370257
6. Jiang H, Chen J, Gao R, Huang Z, Wu M, Song B. Liver fibrosis staging with diffusion-
weighted imaging: a systematic review and meta-analysis. Abdom Radiol (NY). 2017
Feb;42(2):490-501.
PubMed: PM27678393
7. Kim G, Shim KY, Baik SK. Diagnostic accuracy of hepatic vein arrival time performed
with contrast-enhanced ultrasonography for cirrhosis: a systematic review and meta-
analysis. Gut Liver [Internet]. 2017 Jan 15 [cited 2017 Aug 4];11(1):93-101. Available
from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5221866
PubMed: PM27538445
8. Feng JC, Li J, Wu XW, Peng XY. Diagnostic accuracy of SuperSonic shear imaging for
staging of liver fibrosis: a meta-analysis. J Ultrasound Med. 2016 Feb;35(2):329-39.
PubMed: PM26795041
9. Geng XX, Huang RG, Lin JM, Jiang N, Yang XX. Transient elastography in clinical
detection of liver cirrhosis: a systematic review and meta-analysis. Saudi J
Gastroenterol [Internet]. 2016 Jul [cited 2017 Aug 4];22(4):294-303. Available from:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4991200
PubMed: PM27488324
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3732152http://www.ncbi.nlm.nih.gov/pubmed/23516679http://www.health.alberta.ca/documents/AHTDP-ETG-UofC-STE.pdfhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC4781535http://www.ncbi.nlm.nih.gov/pubmed/22333291http://www.ncbi.nlm.nih.gov/pubmed/28370257http://www.ncbi.nlm.nih.gov/pubmed/27678393http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5221866http://www.ncbi.nlm.nih.gov/pubmed/27538445http://www.ncbi.nlm.nih.gov/pubmed/26795041http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4991200http://www.ncbi.nlm.nih.gov/pubmed/27488324
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REFERENCE LIST Non-Invasive Imaging Modalities for the Diagnosis and Monitoring of Liver Fibrosis 6
10. Hashemi SA, Alavian SM, Gholami-Fesharaki M. Assessment of transient elastography
(FibroScan) for diagnosis of fibrosis in non-alcoholic fatty liver disease: a systematic
review and meta-analysis. Caspian J Intern Med [Internet]. 2016 [cited 2017 Aug
4];7(4):242-52. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5153515
PubMed: PM27999641
11. Jiang T, Tian G, Zhao Q, Kong D, Cheng C, Zhong L, et al. Diagnostic accuracy of 2D-
shear wave elastography for liver fibrosis severity: a meta-analysis. PLoS ONE
[Internet]. 2016 [cited 2017 Aug 4];11(6):e0157219. Available from:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4907490
PubMed: PM27300569
12. Li C, Zhang C, Li J, Huo H, Song D. Diagnostic accuracy of real-time shear wave
elastography for staging of liver fibrosis: a meta-analysis. Med Sci Monit [Internet]. 2016
Apr 22 [cited 2017 Aug 4];22:1349-59. Available from:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4844274
PubMed: PM27102449
13. Li Y, Huang YS, Wang ZZ, Yang ZR, Sun F, Zhan SY, et al. Systematic review with
meta-analysis: the diagnostic accuracy of transient elastography for the staging of liver
fibrosis in patients with chronic hepatitis B. Aliment Pharmacol Ther. 2016
Feb;43(4):458-69.
PubMed: PM26669632
14. Njei B, McCarty TR, Luk J, Ewelukwa O, Ditah I, Lim JK. Use of transient elastography
in patients with HIV-HCV coinfection: A systematic review and meta-analysis. J
Gastroenterol Hepatol [Internet]. 2016 Oct [cited 2017 Aug 4];31(10):1684-93. Available
from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5014713
PubMed: PM26952020
15. Pavlov CS, Casazza G, Semenistaia M, Nikolova D, Tsochatzis E, Liusina E, et al.
Ultrasonography for diagnosis of alcoholic cirrhosis in people with alcoholic liver
disease. Cochrane Database Syst Rev. 2016 Mar 2;3:CD011602.
PubMed: PM26934429
16. Pavlov CS, Casazza G, Nikolova D, Tsochatzis E, Gluud C. Systematic review with
meta-analysis: diagnostic accuracy of transient elastography for staging of fibrosis in
people with alcoholic liver disease. Aliment Pharmacol Ther. 2016 Mar;43(5):575-85.
PubMed: PM26791825
17. Shan QY, Liu BX, Tian WS, Wang W, Zhou LY, Wang Y, et al. Elastography of shear
wave speed imaging for the evaluation of liver fibrosis: a meta-analysis. Hepatol Res.
2016 Nov;46(12):1203-13.
PubMed: PM26857658
18. Singh S, Venkatesh SK, Keaveny A, Adam S, Miller FH, Asbach P, et al. Diagnostic
accuracy of magnetic resonance elastography in liver transplant recipients: a pooled
analysis. Ann Hepatol [Internet]. 2016 May [cited 2017 Aug 4];15(3):363-76. Available
from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5032623
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REFERENCE LIST Non-Invasive Imaging Modalities for the Diagnosis and Monitoring of Liver Fibrosis 7
19. Singh S, Venkatesh SK, Loomba R, Wang Z, Sirlin C, Chen J, et al. Magnetic
resonance elastography for staging liver fibrosis in non-alcoholic fatty liver disease: a
diagnostic accuracy systematic review and individual participant data pooled analysis.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5051267
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20. Ying HY, Lu LG, Jing DD, Ni XS. Accuracy of transient elastography in the assessment
of chronic hepatitis C-related liver cirrhosis. Clin Invest Med. 2016 Oct 14;39(5):E150-
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21. Zhang B, Liang L, Dong Y, Lian Z, Chen W, Liang C, et al. intravoxel incoherent motion
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4];11(1):e0147789. Available from:
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22. Guo Y, Parthasarathy S, Goyal P, McCarthy RJ, Larson AC, Miller FH. Magnetic
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23. Pavlov CS, Casazza G, Nikolova D, Tsochatzis E, Burroughs AK, Ivashkin VT, et al.
Transient elastography for diagnosis of stages of hepatic fibrosis and cirrhosis in people
with alcoholic liver disease. Cochrane Database Syst Rev. 2015 Jan 22;1:CD010542.
PubMed: PM25612182
24. Singh S, Venkatesh SK, Wang Z, Miller FH, Motosugi U, Low RN, et al. Diagnostic
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25. Legris C. Assessment of non‐invasive methods for measuring liver fibrosis in chronic
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sante.fr/portail/upload/docs/application/pdf/2015-08/inahta_brief_liver_fibrosis.pdf
Note: Full report in French
26. Su LN, Guo SL, Li BX, Yang P. Diagnostic value of magnetic resonance elastography
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27. Abd El Rihim AY, Omar RF, Fathalah W, El Attar, I, Hafez HA, Ibrahim W. Role of
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REFERENCE LIST Non-Invasive Imaging Modalities for the Diagnosis and Monitoring of Liver Fibrosis 8
28. Nierhoff J, Chavez Ortiz AA, Herrmann E, Zeuzem S, Friedrich-Rust M. The efficiency
of acoustic radiation force impulse imaging for the staging of liver fibrosis: a meta-
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29. Adebajo CO, Talwalkar JA, Poterucha JJ, Kim WR, Charlton MR. Ultrasound-based
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30. Friedrich-Rust M, Nierhoff J, Lupsor M, Sporea I, Fierbinteanu-Braticevici C, Strobel D,
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Overview of Reviews
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Systematic Review of Economic Evaluations
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Pediatric Populations
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Randomized Controlled Trials
No literature identified.
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REFERENCE LIST Non-Invasive Imaging Modalities for the Diagnosis and Monitoring of Liver Fibrosis 9
Economic Evaluations
35. Soto M, Sampietro-Colom L, Lasalvia L, Mira A, Jimenez W, Navasa M. Cost-
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36. Crossan C, Tsochatzis EA, Longworth L, Gurusamy K, Papastergiou V, Thalassinos E,
et al. Cost-effectiveness of noninvasive liver fibrosis tests for treatment decisions in
patients with chronic hepatitis B in the UK: systematic review and economic evaluation.
J Viral Hepat [Internet]. 2016 Feb [cited 2017 Aug 4];23(2):139-49. Available from:
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37. Crossan C, Tsochatzis EA, Longworth L, Gurusamy K, Davidson B, Rodriguez-
Peralvarez M, et al. Cost-effectiveness of non-invasive methods for assessment and
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Guidelines and Recommendations
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42. Myers RP, Shah H, Burak KW, Cooper C, Feld JJ. An update on the management of
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http://www.liver.ca/files/Professional_Education___Partnerships/Information___Resourc
es_for_HCP/CASL_Hep_C_Consensus_Guidelines_Update_-_Jan_2015.pdf
See: Recommendation 10, page 5
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43. European Association for Study of Liver, Asociacion Latinoamericana para el Estudio
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45. Guidelines for the prevention, care and treatment of persons with chronic hepatitis B
infection [Internet]. Geneva (Switzerland): World Health Organization (WHO); 2015 Mar
[cited 2017 Aug 4]. Available from:
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See: Recommendations: noninvasive assessment of liver disease stage at baseline and
during follow up
46. Guidelines for the screening care and treatment of persons with hepatitis C infection.
Geneva (Switzerland): World Health Organization (WHO); 2014 [cited 2017 Aug 4].
Available from:
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See: 6.2 Assessing the degree of liver fibrosis and cirrhosis
47. Hepatitis B (chronic): diagnosis and management [Internet]. London (United Kingdom):
National Institute for Health and Care Excellence (NICE); 2013 Jun [cited 2017 Aug 4].
(Clinical guideline: CG165). Available from: https://www.nice.org.uk/guidance/cg165/
See: Recommendation 1.3.5
48. Coffin CS, Fung SK, Ma MM; Canadian Association for the Study of the Liver.
Management of chronic hepatitis B: Canadian Association for the Study of the Liver
consensus guidelines. Can J Gastroenterol [Internet]. 2012 Dec [cited 2017 Aug
4];26(12):917-38. Available from:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3551569/pdf/cjg26917.pdf
See: Recommendation 9 and 10, page 920
http://www.liver.ca/files/Professional_Education___Partnerships/Information___Resources_for_HCP/CASL_Hep_C_Consensus_Guidelines_Update_-_Jan_2015.pdfhttp://www.liver.ca/files/Professional_Education___Partnerships/Information___Resources_for_HCP/CASL_Hep_C_Consensus_Guidelines_Update_-_Jan_2015.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/25585348http://www.sciencedirect.com/science/article/pii/S0168827815002597?via%3Dihubhttp://www.ncbi.nlm.nih.gov/pubmed/25911335https://www.nice.org.uk/guidance/mtg27/http://apps.who.int/iris/bitstream/10665/154590/1/9789241549059_eng.pdf?ua=1&ua=1http://apps.who.int/iris/bitstream/10665/111747/1/9789241548755_eng.pdf?ua=1&ua=1https://www.nice.org.uk/guidance/cg165/https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3551569/pdf/cjg26917.pdf
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REFERENCE LIST Non-Invasive Imaging Modalities for the Diagnosis and Monitoring of Liver Fibrosis 11
Appendix — Further Information
Previous CADTH Reports
49. Acoustic radiation force impulse imaging for diagnosis and monitoring of liver fibrosis in
patients with hepatitis B: a review of diagnostic accuracy, clinical effectiveness, cost-
effectiveness, and guidelines [Internet]. Ottawa: CADTH; 2016 May [cited 2017 Aug 4].
(CADTH rapid response report: summary with critical appraisal). Available from:
https://www.cadth.ca/acoustic-radiation-force-impulse-imaging-diagnosis-and-
monitoring-liver-fibrosis-patients-hepatitis
50. Acoustic radiation force impulse imaging for diagnosis and monitoring of liver fibrosis in
patients with hepatitis C: a review of diagnostic accuracy, clinical effectiveness, cost-
effectiveness, and guidelines [Internet]. Ottawa: CADTH; 2016 Apr [cited 2017 Aug 4].
(CADTH rapid response report: summary with critical appraisal). Available from:
https://www.cadth.ca/acoustic-radiation-force-impulse-imaging-diagnosis-and-
monitoring-liver-fibrosis-patients-0
51. Non-invasive methods for diagnosis and monitoring of liver fibrosis in patients with
chronic hepatitis B and C: a review of diagnostic accuracy, clinical effectiveness, cost-
effectiveness and guidelines [Internet]. Ottawa: CADTH; 2015 Jun [cited 2017 Aug 4].
(CADTH rapid response report: summary with critical appraisal). Available from:
https://www.cadth.ca/non-invasive-methods-diagnosis-and-monitoring-liver-fibrosis-
patients-chronic-hepatitis-b-and-c-0
52. Diagnosis and monitoring of liver fibrosis in patients with chronic hepatitis C: a review of
the clinical evidence and cost effectiveness [Internet]. Ottawa: CADTH; 2012 Mar [cited
2017 Aug 4]. (CADTH rapid response report: summary with critical appraisal). Available
from: https://www.cadth.ca/diagnosis-and-monitoring-liver-fibrosis-patients-chronic-
hepatitis-c-review-clinical-evidence-and
Non-Randomized Studies – Not Formally Searched
53. Franca M, Marti-Bonmati L, Alberich-Bayarri A, Oliveira P, Guimaraes S, Oliveira J, et
al. Evaluation of fibrosis and inflammation in diffuse liver diseases using intravoxel
incoherent motion diffusion-weighted MR imaging. Abdom Radiol (NY). 2017
Feb;42(2):468-77.
PubMed: PM27638516
54. Koyama N, Hata J, Sato T, Tomiyama Y, Hino K. Assessment of hepatic fibrosis with
superb microvascular imaging in hepatitis C virus-associated chronic liver diseases.
Hepatol Res. 2017 May;47(6):593-7.
PubMed: PM27433927
55. Pfeifer L, Zopf S, Siebler J, Schwitulla J, Wildner D, Wachter D, et al. Prospective
evaluation of acoustic radiation force impulse (ARFI) elastography and high-frequency
b-mode ultrasound in compensated patients for the diagnosis of liver fibrosis/cirrhosis in
comparison to mini-laparoscopic biopsy. Ultraschall Med. 2015 Dec;36(6):581-9.
PubMed: PM26529354
https://www.cadth.ca/acoustic-radiation-force-impulse-imaging-diagnosis-and-monitoring-liver-fibrosis-patients-hepatitishttps://www.cadth.ca/acoustic-radiation-force-impulse-imaging-diagnosis-and-monitoring-liver-fibrosis-patients-hepatitishttps://www.cadth.ca/acoustic-radiation-force-impulse-imaging-diagnosis-and-monitoring-liver-fibrosis-patients-0https://www.cadth.ca/acoustic-radiation-force-impulse-imaging-diagnosis-and-monitoring-liver-fibrosis-patients-0https://www.cadth.ca/non-invasive-methods-diagnosis-and-monitoring-liver-fibrosis-patients-chronic-hepatitis-b-and-c-0https://www.cadth.ca/non-invasive-methods-diagnosis-and-monitoring-liver-fibrosis-patients-chronic-hepatitis-b-and-c-0https://www.cadth.ca/diagnosis-and-monitoring-liver-fibrosis-patients-chronic-hepatitis-c-review-clinical-evidence-andhttps://www.cadth.ca/diagnosis-and-monitoring-liver-fibrosis-patients-chronic-hepatitis-c-review-clinical-evidence-andhttp://www.ncbi.nlm.nih.gov/pubmed/27638516http://www.ncbi.nlm.nih.gov/pubmed/27433927http://www.ncbi.nlm.nih.gov/pubmed/26529354
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REFERENCE LIST Non-Invasive Imaging Modalities for the Diagnosis and Monitoring of Liver Fibrosis 12
56. Samir AE, Dhyani M, Vij A, Bhan AK, Halpern EF, Mendez-Navarro J, et al. Shear-wave
elastography for the estimation of liver fibrosis in chronic liver disease: determining
accuracy and ideal site for measurement. Radiology [Internet]. 2015 Mar [cited 2017
Aug 4];274(3):888-96. Available from:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4455676
PubMed: PM25393946
57. Beland MD, Brown SF, Machan JT, Taliano RJ, Promrat K, Cronan JJ. A pilot study
estimating liver fibrosis with ultrasound shear-wave elastography: does the cause of
liver disease or location of measurement affect performance? AJR Am J Roentgenol.
2014 Sep;203(3):W267-W273.
PubMed: PM25148183
58. Poynard T, de Ledinghen, V, Zarski JP, Stanciu C, Munteanu M, Vergniol J, et al.
Relative performances of FibroTest, Fibroscan, and biopsy for the assessment of the
stage of liver fibrosis in patients with chronic hepatitis C: a step toward the truth in the
absence of a gold standard. J Hepatol. 2012 Mar;56(3):541-8.
PubMed: PM21889468
Economic Evaluations – Alternative Comparator
59. Nishie A, Goshima S, Haradome H, Hatano E, Imai Y, Kudo M, et al. Cost-effectiveness
of EOB-MRI for Hepatocellular Carcinoma in Japan. Clin Ther. 2017 Apr;39(4):738-50.
PubMed: PM28363694
Clinical Practice Guidelines – Uncertain Methodology
60. Lim JK, Flamm SL, Singh S, Falck-Ytter YT, Clinical Guidelines Committee of the
American Gastroenterological Association. American Gastroenterological Association
Institute guideline on the role of elastography in the evaluation of liver fibrosis.
Gastroenterology. 2017 May;152(6):1536-43.
PubMed: PM28442119
61. Shiha G, Ibrahim A, Helmy A, Sarin SK, Omata M, Kumar A, et al. Asian-Pacific
Association for the Study of the Liver (APASL) consensus guidelines on invasive and
non-invasive assessment of hepatic fibrosis: a 2016 update. Hepatol Int. 2017
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62. Ricke J, Seidensticker M, Mohnike K. Noninvasive diagnosis of hepatocellular
carcinoma in cirrhotic liver: current guidelines and future prospects for radiological
imaging. Liver Cancer [Internet]. 2012 Jun [cited 2017 Aug 4];1(1):51-8. Available from:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3747541
PubMed: PM24159571
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4455676http://www.ncbi.nlm.nih.gov/pubmed/25393946http://www.ncbi.nlm.nih.gov/pubmed/25148183http://www.ncbi.nlm.nih.gov/pubmed/21889468http://www.ncbi.nlm.nih.gov/pubmed/28363694http://www.ncbi.nlm.nih.gov/pubmed/28442119http://www.ncbi.nlm.nih.gov/pubmed/27714681http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3747541http://www.ncbi.nlm.nih.gov/pubmed/24159571
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