modalities for the diagnosis and monitoring of liver · reference list non-invasive imaging...

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

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:

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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.


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


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:


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:


PubMed: PM22333291

Systematic Reviews and Meta-analyses

Adult Populations

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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:


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


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:


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:


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.

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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


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


PubMed: PM27049490

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5153515http://www.ncbi.nlm.nih.gov/pubmed/27999641http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4907490http://www.ncbi.nlm.nih.gov/pubmed/27300569http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4844274http://www.ncbi.nlm.nih.gov/pubmed/27102449http://www.ncbi.nlm.nih.gov/pubmed/26669632http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5014713http://www.ncbi.nlm.nih.gov/pubmed/26952020http://www.ncbi.nlm.nih.gov/pubmed/26934429http://www.ncbi.nlm.nih.gov/pubmed/26791825http://www.ncbi.nlm.nih.gov/pubmed/26857658http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5032623http://www.ncbi.nlm.nih.gov/pubmed/27049490


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.

Eur Radiol [Internet]. 2016 May [cited 2017 Aug 4];26(5):1431-40. Available from:


PubMed: PM26314479

20. Ying HY, Lu LG, Jing DD, Ni XS. Accuracy of transient elastography in the assessment

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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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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.

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24. Singh S, Venkatesh SK, Wang Z, Miller FH, Motosugi U, Low RN, et al. Diagnostic

performance of magnetic resonance elastography in staging liver fibrosis: a systematic

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[Internet]. 2015 Mar [cited 2017 Aug 4];13(3):440-51. Available from:


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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

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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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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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Economic Evaluations

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PubMed: PM28533673

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:


PubMed: PM26444996

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

monitoring of liver fibrosis and cirrhosis in patients with chronic liver disease: systematic

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38. Tsochatzis EA, Crossan C, Longworth L, Gurusamy K, Rodriguez-Peralvarez M,

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decisions in patients with chronic hepatitis C. Hepatology [Internet]. 2014 Sep [cited

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Guidelines and Recommendations

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es_for_HCP/CASL_Hep_C_Consensus_Guidelines_Update_-_Jan_2015.pdf

See: Recommendation 10, page 5

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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.

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See: Recommendation 1.3.5

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4];26(12):917-38. Available from:

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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


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].


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