Shear Wave Elastography For Assessment Of Biopsy-Proven Renal Fibrosis: A Systematic Review And Meta-Analysis

Background and Aim:Shear wave elastography(SWE)is an ultrasound-based technique used to stage renal fibrosis in chronic kidney disease(CKD)by measuring kidney stiffness(KS).SWE has been shown to be an effective method for assessing renal fibrosis in small to medium-sized clinical trials.However,the results of previous studies have not been entirely consistent.No one has yet pooled and performed a meta-analysis of these primary studies to assess the overall performance of SWE in terms of renal fibrosis staging.The aim of our study was to perform a larger meta-analysis of individual data using renal tissue biopsy as the reference standard to investigate the diagnostic performance of SWE on the staging of renal fibrosis in patients with CKD and analyzed the factors affecting the diagnostic accuracy.Methods:Studies in the Cochrane Library,Medline,Pub Med,Web of Science,Embase,and CNKI databases from January 2009 to April 2022 were searched and screened for studies assessing the diagnostic performance of two-dimensional-SWE(2D-SWE)and point SWE(p SWE)in renal fibrosis.The random effects models in Stata 16.0software were used to calculate the summary sensitivity(S-Sen),specificity(S-Spe),diagnostic odds ratio(DOR)and area under the ROC curve(AUROC).The Quality Assessment of Diagnostic Accuracy Studies-2 tool(QUADAS-2)was used to assess study quality and meta-regression analysis was used to identify sources of heterogeneity.Results:1,394 patients from 14 studies were included in the final analysis.The S-Sens of SWE for assessing mild,moderate,and severe renal fibrosis were 0.79(95%confidence interval [CI]: 0.67-0.88),0.73(95% CI: 0.65-0.80),and 0.87(95% CI:0.71-0.95),respectively;The S-Spes were 0.82(95% CI: 0.75-0.87),0.72(95% CI:0.67-0.77),and 0.83(95% CI: 0.80-0.86),respectively;AUROCs were 0.87(95% CI:0.84-0.90),0.78(95% CI: 0.75-0.82),and 0.86(95% CI: 0.82-0.88),respectively;DORs were 17(95% CI: 7-43),7(95% CI: 4-12),and 34(95% CI: 13-88),respectively.Meta-regressions showed that the publication date,system used and number of valid measurements were the main causes of heterogeneity.Conclusion:The result of this meta-analysis showed that SWE is a good technique for the diagnosis of renal fibrosis,especially in the mild and severe fibrosis.