Meta-Analysis
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 14, 2020; 26(18): 2247-2267
Published online May 14, 2020. doi: 10.3748/wjg.v26.i18.2247
Computed tomography vs liver stiffness measurement and magnetic resonance imaging in evaluating esophageal varices in cirrhotic patients: A systematic review and meta-analysis
Yue Li, Lei Li, Hong-Lei Weng, Roman Liebe, Hui-Guo Ding
Yue Li, Lei Li, Hui-Guo Ding, Department of Gastroenterology and Hepatology, Beijing You’an Hospital Affiliated with Capital Medical University, Beijing 100069, China
Hong-Lei Weng, Department of Medicine II, Section Molecular Hepatology, Medical Faculty Mannheim, Heidelberg University, Mannheim 68167, Germany
Roman Liebe, Department of Medicine II, Saarland University Medical Center, Homburg 66424, Germany
Author contributions: Li Y and Li L contributed equally to collecting the data and writing the manuscript; Ding HG designed the project and was in charge of the manuscript; Weng HL and Liebe R performed the language editing; all authors have read and approved the manuscript.
Supported by the State Key Projects Specialized on Infectious Diseases, No. 2017ZX10203202–004; Beijing Municipal Administration of Hospitals Clinical Medicine Development of Special Funding, No. ZYLX201610; Beijing Municipal Administration of Hospitals’ Ascent Plan, No. DFL20151602; and Digestive Medical Coordinated Development Center of Beijing Hospitals Authority, No. XXT24.
Conflict-of-interest statement: The authors deny any conflict of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Hui-Guo Ding, MD, PhD, Chief Doctor, Chief Physician, Professor, Department of Gastroenterology and Hepatology, Beijing You’an Hospital affiliated with Capital Medical University, 8 Xitoutiao, Youanmenwai, Fengtai District, Beijing 100069, China. dinghuiguo@ccmu.edu.cn
Received: February 13, 2020
Peer-review started: February 13, 2020
First decision: March 15, 2020
Revised: March 19, 2020
Accepted: April 24, 2020
Article in press: April 24, 2020
Published online: May 14, 2020
Processing time: 90 Days and 23.1 Hours
Abstract
BACKGROUND

Computed tomography (CT), liver stiffness measurement (LSM), and magnetic resonance imaging (MRI) are non-invasive diagnostic methods for esophageal varices (EV) and for the prediction of high-bleeding-risk EV (HREV) in cirrhotic patients. However, the clinical use of these methods is controversial.

AIM

To evaluate the accuracy of LSM, CT, and MRI in diagnosing EV and predicting HREV in cirrhotic patients.

METHODS

We performed literature searches in multiple databases, including PubMed, Embase, Cochrane, CNKI, and Wanfang databases, for articles that evaluated the accuracy of LSM, CT, and MRI as candidates for the diagnosis of EV and prediction of HREV in cirrhotic patients. Summary sensitivity and specificity, positive likelihood ratio and negative likelihood ratio, diagnostic odds ratio, and the areas under the summary receiver operating characteristic curves were analyzed. The quality of the articles was assessed using the quality assessment of diagnostic accuracy studies-2 tool. Heterogeneity was examined by Q-statistic test and I2 index, and sources of heterogeneity were explored using meta-regression and subgroup analysis. Publication bias was evaluated using Deek’s funnel plot. All statistical analyses were conducted using Stata12.0, MetaDisc1.4, and RevMan5.3.

RESULTS

Overall, 18, 17, and 7 relevant articles on the accuracy of LSM, CT, and MRI in evaluating EV and HREV were retrieved. A significant heterogeneity was observed in all analyses (P < 0.05). The areas under the summary receiver operating characteristic curves of LSM, CT, and MRI in diagnosing EV and predicting HREV were 0.86 (95% confidence interval [CI]: 0.83-0.89), 0.91 (95%CI: 0.88-0.93), and 0.86 (95%CI: 0.83-0.89), and 0.85 (95%CI: 0.81-0.88), 0.94 (95%CI: 0.91-0.96), and 0.83 (95%CI: 0.79-0.86), respectively, with sensitivities of 0.84 (95%CI: 0.78-0.89), 0.91 (95%CI: 0.87-0.94), and 0.81 (95%CI: 0.76-0.86), and 0.81 (95%CI: 0.75-0.86), 0.88 (95%CI: 0.82-0.92), and 0.80 (95%CI: 0.72-0.86), and specificities of 0.71 (95%CI: 0.60-0.80), 0.75 (95%CI: 0.68-0.82), and 0.82 (95%CI: 0.70-0.89), and 0.73 (95%CI: 0.66-0.80), 0.87 (95%CI: 0.81-0.92), and 0.72 (95%CI: 0.62-0.80), respectively. The corresponding positive likelihood ratios were 2.91, 3.67, and 4.44, and 3.04, 6.90, and2.83; the negative likelihood ratios were 0.22, 0.12, and 0.23, and 0.26, 0.14, and 0.28; the diagnostic odds ratios were 13.01, 30.98, and 19.58, and 11.93, 49.99, and 10.00. CT scanner is the source of heterogeneity. There was no significant difference in diagnostic threshold effects (P > 0.05) or publication bias (P > 0.05).

CONCLUSION

Based on the meta-analysis of observational studies, it is suggested that CT imaging, a non-invasive diagnostic method, is the best choice for the diagnosis of EV and prediction of HREV in cirrhotic patients compared with LSM and MRI.

Keywords: Multidetector computed tomography imaging; Magnetic resonance imaging; Liver stiffness measurement; Liver cirrhosis; Esophageal varices; Meta-analysis

Core tip: To date, endoscopy is regarded as the “gold standard” for diagnosis of esophageal varices (EV) and prediction of high-bleeding-risk EV (HREV) in cirrhotic patients. This study came into the conclusion that computed tomography has higher accuracy in diagnosing EV and predicting HREV than liver stiffness measurement and magnetic resonance imaging in cirrhotic patients. It is suggested that computed tomography, a non-invasive diagnostic method, is the best choice for diagnosing EV and predicting HREV in cirrhotic patients compared with liver stiffness measurement and magnetic resonance imaging. However, in future, the head-to-head comparisons of these imaging tools in the same series of patients are required to confirm the predictive value, especially by using artificial intelligence technique.