Diagnostic performance of point shear wave elastography and vibration-controlled transient elastography in paediatric metabolic dysfunction-associated steatotic liver disease: a systematic review and meta-analysis.

Abstract

This study aimed to comprehensively assess the diagnostic accuracy of point shear wave elastography (pSWE) and vibration-controlled transient elastography (VCTE) in paediatric metabolic dysfunction-associated steatotic liver disease (MASLD). Systematic review and meta-analysis of diagnostic test accuracy using the Grading of Recommendations Assessment, Development and Evaluation approach with random-effects models. PubMed, Embase, Web of Science, Ovid (Medline), Cochrane, China National Knowledge Infrastructure, Wan Fang and OpenGrey were searched for publications from April 1989 to July 2024. The study included relevant records on the application of pSWE and VCTE in diagnosing MASLD in children (<19 years). These studies evaluated the diagnostic performance (sensitivity, specificity, area under the receiver operating characteristic curve) of two techniques for paediatric MASLD in the context of a relative gold standard with no language barriers. Studies of children with concurrent liver diseases were excluded. Two independent reviewers extracted data and assessed the risk of bias. Articles were assessed using Quality Assessment of Diagnostic Accuracy Studies 2 for diagnostic accuracy and potential biases, and bias risks were visually represented using the Risk of Bias Visualisation tool. Heterogeneity was assessed (Cochran Q statistic) and quantified (I² statistic). The analysis of the likelihood ratio graph (Fagan plot) indicates that both pSWE and VCTE provide valuable diagnostic support for MASLD. The comprehensive literature search yielded four pSWE studies encompassing 968 children and seven VCTE studies encompassing 1934 children. In our meta-analysis, VCTE had a sensitivity of 0.89 (95% CI, 0.79 to 0.94) and a specificity of 0.90 (95% CI, 0.83 to 0.95), which showed superior diagnostic accuracy compared with pSWE (sensitivity, 0.89 (95% CI, 0.81 to 0.94); specificity, 0.85 (95% CI, 0.81 to 0.89)). While both pSWE and VCTE demonstrated appreciable diagnostic efficacy in paediatric MASLD, VCTE showed similar sensitivity but superior specificity, emerging as the more effective technique particularly in non-obese children. However, further investigation is warranted to fully elucidate the influence of probe selection and racial prevalence on these diagnostic modalities. CRD42024514246.