SynthesisJournal of hepatology2023
An individual patient data meta-analysis to determine cut-offs for and confounders of NAFLD-fibrosis staging with magnetic resonance elastography.
Synthesis in Journal of hepatology, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 81 papers, 5 of them syntheses that pooled it.
What it found
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
81 citing papers in PubMed, 5 syntheses or guidelines pooled it, 82 citations in OpenAlex.
- Evidence-based clinical practice guidelines for metabolic dysfunction-associated steatotic liver disease (MASLD) 2026.Journal of gastroenterology · 2026Guideline
- Diagnostic accuracy of Agile-4 score for liver cirrhosis in patients with metabolic dysfunction-associated steatotic liver disease. A systematic review and meta-analysis of diagnostic test accuracy studies.Diabetes, obesity & metabolism · 2025Pooled it
- KASL clinical practice guidelines for noninvasive tests to assess liver fibrosis in chronic liver disease.Clinical and molecular hepatology · 2024Guideline
- Optimal cut-offs of vibration-controlled transient elastography and magnetic resonance elastography in diagnosing advanced liver fibrosis in patients with nonalcoholic fatty liver disease: A systematic review and meta-analysis.Clinical and molecular hepatology · 2024Pooled it
- EASL-EASD-EASO Clinical Practice Guidelines on the Management of Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD).Obesity facts · 2024Guideline
- Detection of undiagnosed liver cirrhosis via AI-enabled electrocardiogram: a pragmatic, cluster-randomized clinical trial.Nature medicine · 2026Trial
- BMI-dependent discordance between transient and MR elastography: risk of fibrosis overestimation in severe obesity.Abdominal radiology (New York) · 2026Article
- Screening and diagnosis of liver disease in diabetes: a guide and evidence-based assessment.Diabetologia · 2026Review
- ESR Bridges: high-risk steatotic liver disease: new developments in non-invasive tests and treatment-a multidisciplinary view.European radiology · 2026Article
- Review
- MRI risk stratification in metabolic dysfunction-associated steatotic liver disease (MASLD): from diffuse liver disease to focal lesions.Abdominal radiology (New York) · 2026Review
- Closer Association of Liver Stiffness Than Liver Fat Content With Imaging-Derived Neurovascular Coupling in a Metabolic Dysfunction-Associated Steatotic Liver Disease Cohort.Diabetes, obesity & metabolism · 2026Article
- Quantitative equivalence of Quantitative Imaging Biomarkers Alliance (QIBA)-2023- and QIBA-2020-compliant MR elastography protocols for liver stiffness assessment.Abdominal radiology (New York) · 2026Article
- Noninvasive surrogate endpoints in MASH trials: current perspectives and challenges.Hepatology international · 2026Review
- Steatotic liver disease: non-invasive assessment and biomarkers across metabolic dysfunction-associated steatotic liver disease, metabolic dysfunction-associated steatotic liver disease with moderate alcohol consumption and alcohol-associated liver disease.Clinical and molecular hepatology · 2026Review
- Diffusion-Weighted Imaging-Based Virtual MR Elastography of the Liver: Beyond Mechanical Waves.Korean journal of radiology · 2026Review
- European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) steatotic liver disease special interest group position paper on screening, diagnosis and investigation of paediatric metabolic dysfunction-associated steatotic liver disease.Journal of pediatric gastroenterology and nutrition · 2026Article
- Steatotic liver disease trajectory: A holistic EASL guidance on the multidisciplinary approach to screening and patient management.JHEP reports : innovation in hepatology · 2026Review
- MRI in MASLD: technical foundations and guideline-based applications.BMJ open gastroenterology · 2026Review
- Clinical trial endpoints for metabolic dysfunction and alcohol associated steatotic liver disease.Hepatology international · 2026Review
21 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
19 authors at 14 institutions in 7 countries.
Funding
Abstract
BACKGROUND &
aimsWe conducted an individual patient data meta-analysis to establish stiffness cut-off values for magnetic resonance elastography (MRE) in staging liver fibrosis and to assess potential confounding factors.
methodsA systematic review of the literature identified studies reporting MRE data in patients with NAFLD. Data were obtained from the corresponding authors. The pooled diagnostic cut-off value for the various fibrosis stages was determined in a two-stage meta-analysis. Multilevel modelling methods were used to analyse potential confounding factors influencing the diagnostic accuracy of MRE in staging liver fibrosis.
resultsEight independent cohorts comprising 798 patients were included in the meta-analysis. The area under the receiver operating characteristic curve (AUROC) for MRE in detecting significant fibrosis was 0.92 (sensitivity, 79%; specificity, 89%). For advanced fibrosis, the AUROC was 0.92 (sensitivity, 87%; specificity, 88%). For cirrhosis, the AUROC was 0.94 (sensitivity, 88%, specificity, 89%). Cut-offs were defined to explore concordance between MRE and histopathology: ≥F2, 3.14 kPa (pretest probability, 39.4%); ≥F3, 3.53 kPa (pretest probability, 24.1%); and F4, 4.45 kPa (pretest probability, 8.7%). In generalized linear mixed model analysis, histological steatohepatitis with higher inflammatory activity (odds ratio 2.448, 95% CI 1.180-5.079, p <0.05) and high gamma-glutamyl transferase (GGT) concentration (>120U/L) (odds ratio 3.388, 95% CI 1.577-7.278, p <0.01] were significantly associated with elevated liver stiffness, and thus affecting accuracy in staging early fibrosis (F0-F1). Steatosis, as measured by magnetic resonance imaging proton density fat fraction, and body mass index(BMI) were not confounders.
conclusionsMRE has excellent diagnostic performance for significant, advanced fibrosis and cirrhosis in patients with NAFLD. Elevated inflammatory activity and GGT level may lead to overestimation of early liver fibrosis, but anthropometric measures such as BMI or the degree of steatosis do not. IMPACT AND IMPLICATIONS: This individual patient data meta-analysis of eight international cohorts, including 798 patients, demonstrated that MRE achieves excellent diagnostic accuracy for significant, advanced fibrosis and cirrhosis in patients with NAFLD. Cut-off values (significant fibrosis, 3.14 kPa; advanced fibrosis, 3.53 kPa; and cirrhosis, 4.45 kPa) were established. Elevated inflammatory activity and gamma-glutamyltransferase level may affect the diagnostic accuracy of MRE, leading to overestimation of liver fibrosis in early stages. We observed no impact of diabetes, obesity, or any other metabolic disorder on the diagnostic accuracy of MRE.
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