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Updated: Jun 5, 2026
A Three-Dimensional Digital Model for Early Diagnosis of Hepatic Fibrosis Based on Magnetic Resonance Elastography
Published on: July 21, 2023
Rule-Out Cutoff of Two-Dimensional Shear Wave Elastography for Significant Fibrosis in Metabolic
Joo Hyun Oh1, Jonghyun Lee2, Miyoung Choi3
1Department of Gastroenterology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea.
Background & Aims:
Two-dimensional shear-wave elastography is a practical method for assessing liver fibrosis. However, an optimal cutoff value to rule out significant fibrosis (≥F2) in metabolic dysfunction-associated steatotic liver disease remains unclear. This study aimed to determine the evidence-based rule-out cutoff through diagnostic meta-analysis.
Methods:
A systematic review was of MEDLINE, EMBASE, and Cochrane CENTRAL was performed through December 2025 for studies evaluating 2-dimensional shear-wave elastography with liver biopsy as the reference standard. Pooled sensitivity, specificity, and summary area under the receiver operating characteristic curve were estimated. The rule-out cutoff was defined as the highest threshold achieving pooled sensitivity ≥80%. External validation was performed using an independent clinical cohort.
Results:
Twenty-two studies involving 3171 adults with biopsy-proven metabolic dysfunction-associated steatotic liver disease were analyzed. The summary area under the receiver operating characteristic curve was 0.84 (95% confidence interval, 0.81-0.87), with pooled sensitivity of 79.6% and specificity of 76.0%. The rule-out cutoff of 6.6 kPa (95% confidence interval, 5.4-8.2 kPa) achieved sensitivity of 80.0% and specificity of 70.7%. At this threshold, negative predictive value exceeded 95% at prevalences of 5% and 10%. Diagnostic performance was generally preserved across subgroups but was modestly attenuated in populations with greater metabolic burden and in studies using Supersonic ultrasound platforms. External validation (N = 163) demonstrated consistent sensitivity (0.86) and specificity (0.68).
Conclusions:
Two-dimensional shear-wave elastography demonstrated good diagnostic accuracy for significant fibrosis in metabolic dysfunction-associated steatotic liver disease. A liver stiffness of 6.6 kPa can reliably rule out significant fibrosis. As 2-dimensional shear-wave elastography can be integrated into conventional ultrasound systems, it may facilitate broader implementation of fibrosis screening beyond specialized centers.
Clinical Trial Number:
PROSPERO (International Prospective Register of Systematic Reviews), CRD42024616042.
