Accuracy of non-invasive tests for diagnosing liver fibrosis and steatosis: A systematic review

Table 1 Elastography assessment results

Ref.	Population	Test	Cut-off	Target	Sensitivity (%)	Specificity (%)	AUROC	PPV (%)	NPV (%)
Elastography studies
Atzori et al[12]	Mixed CLD (n = 150)	TE	9.7 kPa	≥ F3	79	75	0.841
		TE	16.5 kPa	F4	93	91	0.939
		ElastPQ	8.32 kPa	≥ F3	76	71	0.812
		ElastPQ	10.41 kPa	F4	83	73	0.856
		VTQ ARFI	10.88 kPa	≥ F3	76	72	0.782
		VTQ ARFI	12.47 kPa	F4	69	78	0.826
Kovatsch et al[13]	CLD	2D-SWE		≥ F2	76.4	86	0.852
		2D-SWE		≥ F3	75.6	88.1	0.868
		2D-SWE		F4			0.956
		TE		≥ F2			0.875
		TE		≥ F3			0.868
		TE		F4			0.956
Liguori et al[11]	MASLD	2D-SWE	7.2 kPa	≥ F3			0.9
		TE	8.4 kPa	≥ F3			0.93
		Vi PLUS	2.1 kPa	Fibrosis	100	58.1	0.81
Liguori et al[12]	MASLD/MASH	S-Shearwave	8.1 kPa	≥ F3	95.6	78.8	0.942
		TE	8.9 kPa	≥ F3	95.6	94.2	0.979
		2D-SWE	7.6 kPa	≥ F3	82.6	84.6	0.906
		FIB-4		≥ F3			0.768
		NFS		≥ F3			0.833
Liu et al[14]	CHB + MASLD (n = 368)	VCTE (LSM)	11.25 kPa	Cirrhosis	79	90	0.86	89	81
		CAP	313 dB/m	Severe steatosis	86	82	0.84	82	85
Serum biomarker studies
Kang et al[20]	MASLD (n = 153)	ELF	9.6	F3-F4	67.9	84	0.829	48.7	89.2
		FIB-4 to ELF	ELF 9.8	F3-F4	67.9	90.4	0.791	75.2	86.8
Younossi et al[21]	NAFLD (n = 829)	ELF		Advanced fibrosis			0.811
		ELF + FIB-4 (low)	ELF ≥ 7.2, FIB-4 ≥ 0.74	Rule out	92.5				95.1
		ELF + FIB-4 (high)	ELF ≥ 9.8, FIB-4 ≥ 2.9	Rule in		99.7		95
Modeling study
Tapper et al[28]	NAFLD (model)	FIB-4		≥ F3	69-772	70
		ELF	9.37	≥ F3	73	80
		VCTE	9.1 kPa	≥ F3	77	78

¹Area under the receiver operating characteristic reported for the detection of advanced fibrosis; sensitivity and specificity were not provided separately in the original study.

²Sensitivity is presented as a range because different diagnostic thresholds or scenarios were evaluated in the modeling study.

CLD: Chronic liver disease; MASLD: Metabolic dysfunction-associated steatotic liver disease; MASH: Metabolic dysfunction-associated steatohepatitis; CHB: Chronic Hepatitis B; NAFLD: Non-alcoholic fatty liver disease; NFS: NAFLD fibrosis score; TE: Transient elastography; VTQ: Virtual touch quantification; ARFI: Acoustic radiation force impulse; 2D: Two-dimensional; SWE: Shear wave elastography; Vi PLUS: Viscosity plane-wave ultrasound; VCTE: Vibration-controlled transient elastography; LSM: Liver stiffness measurement; CAP: Controlled attenuation parameter; ELF: Enhanced liver fibrosis; FIB-4: Fibrosis-4 index; AUROC: Area under the receiver operating characteristic; PPV: Positive predictive value; NPV: Negative predictive value.