Spleen Stiffness on Magnetic Resonance Elastography for the Detection of Portal Hypertension: A Systematic Review and Meta-Analysis

Chronic liver disease, complicated by portal hypertension (PH), may alter the extra-hepatic he-modynamic condition and spleen stiffness (SS). We aimed to evaluate the diagnostic accuracy of MRI-based elastographic methods (MRE) for detecting PH.

Seven studies were included with reference to SS with regard to the prediction of PH patients. Ma-jor outcomes considered for data extraction were diagnostic parameters for MRI for concluding mild PH, clini-cally significant PH and severe PH. PubMed, Scopus, Google Scholar, Cochrane and Science Direct databases were used to extract the published literature through to May, 2021Using the Rayyan Zotero and R softwares

Out of 587 studies extracted, 7 were selected based on inclusion and exclusion criteria.A QUADAS-2 assessment showed that all studies were clear in terms of patient selection and reference standard.A funnel plot showed that all the selected studies were outliers, indicating a low level of accuracy for the studies included.Subgroup analysis, with reference to SS as a predictor of PH, revealed raw mean difference (RMD) of 7.78% (95% CI 5.23-10.34, P<0.01). The corresponding RMD observed for <60 years and >60 yr were 34.26% (95% CI 9.33-59.20, I2=100%, 휏2=646.7688, P=0), and 46.92% (95% CI 20-59.33, I2=97%, 휏2=1003.023, P=0) re-spectively.The specificity and sensitivity noted for MRI in determining SS were 0.721 and 0.747, respectively with an area-under the curve of 0.788.The estimated random effect models for specificity and sensitivity were 0.938 and 0.842, respectively.

The real-time MRE has acceptable specificity and sensitivity for diagnosing SS.