Systematic Reviews
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Feb 27, 2025; 17(2): 100033
Published online Feb 27, 2025. doi: 10.4254/wjh.v17.i2.100033
Modern ultrasound techniques for diagnosing liver steatosis and fibrosis: A systematic review with a focus on biopsy comparison
Patryk Pozowski, Mateusz Bilski, Maciej Bedrylo, Paweł Sitny, Urszula Zaleska-Dorobisz
Patryk Pozowski, Mateusz Bilski, Maciej Bedrylo, Paweł Sitny, Urszula Zaleska-Dorobisz, Department of General and Pediatric Radiology, Wroclaw Medical University, Wrocław 50-367, Lower Silesia, Poland
Author contributions: Pozowski P and Zaleska-Dorobisz U designed the review; Pozowski P and Bilski M performed the searches, bias analyses, and syntheses related to liver fibrosis, while Bedrylo M and Sitny P performed the searches, bias analyses, and syntheses related to liver steatosis; Zaleska-Dorobisz U provided general supervision for both parts and analyzed the evidence obtained; Bilski M and Zaleska-Dorobisz U synthesized both parts; Pozowski P identified clinical implications and directions for further research.
Supported by Wroclaw Medical University’s Grant, No. SUBZ.C270.24.078.
Conflict-of-interest statement: Authors declare no 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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Patryk Pozowski, MD, Doctor, Department of General and Pediatric Radiology, Wroclaw Medical University, Wybrzeże Ludwika Pasteura 1, Wrocław 50-367, Lower Silesia, Poland. patrykpozowski@gmail.com
Received: August 5, 2024
Revised: December 4, 2024
Accepted: January 24, 2025
Published online: February 27, 2025
Processing time: 198 Days and 10.5 Hours
Abstract
BACKGROUND

This review evaluated the diagnostic effectiveness of various ultrasound (US) methods compared to liver biopsy.

AIM

To determine the diagnostic accuracy of US techniques in assessing liver fibrosis and steatosis in adults, using the area under the receiver operating characteristic curve (AUROC) as the standard measure.

METHODS

The review included original retrospective or prospective studies published in the last three years in peer-reviewed medical journals, that reported AUROC values. Studies were identified through PubMed searches on January 3 and April 30, 2024. Quality was assessed using the QUADAS-2 tool. Results were tabulated according to the diagnostic method and the type of liver pathology.

RESULTS

The review included 52 studies. For liver fibrosis detection, 2D-shear wave elastography (SWE) AUROCs ranged from 0.54 to 0.994, showing better accuracy for advanced stages. Modifications, including 2D-SWE with propagation map guidance and supersonic imagine achieved AUROCs of 0.84 to nearly 1.0. point SWE and classical SWE had AUROCs of 0.741-0.99, and 0.507-0.995, respectively. Transient elastography (TE), visual TE, vibration-controlled TE (VCTE), and FibroTouch reported AUROCs close to 1.0. For steatosis, VCTE with controlled attenuation parameter showed AUROCs up to 0.89 (for ≥ S1), acoustic radiation force impulse ranged from 0.762 to 0.784, US attenuation parameter from 0.88 to 0.93, and normalized local variance measurement from 0.583 to 0.875. Most studies had a low risk of bias across all or most domains, but evidence was limited by variability in study quality and small sample sizes. Innovative SWE variants were evaluated in a single study.

CONCLUSION

Modern US techniques can serve as effective noninvasive diagnostic tools for liver fibrosis and steatosis, with the potential to reduce the reliance on biopsies.

Keywords: Ultrasound diagnosis; Liver steatosis; Liver fibrosis; Diagnostic accuracy; Liver biopsy

Core Tip: This study demonstrates that advancements in shear wave elastography and other ultrasound (US) methods allow for increasingly higher diagnostic accuracy. Several methods with area under the receiver operating characteristic curves slightly worse than 1.0 are described. For fibrosis, lower diagnostic accuracy was observed in earlier stages. However, the diagnostic value of US methods will probably resemble that of biopsy, questioning the rationale of sampling. For steatosis, the options remain less effective, and studies are fewer, but promising US modalities are emerging.