Title: The diagnostic accuracy of US, CT, MR-imaging and 1H-MRS for the evaluation of hepatic steatosis compared with liver biopsy: A meta-analysis

Journal name: European Radiology

Authors:

Anneloes E. Bohte, MD. Corresponding author ()

Jochem R. van Werven, MD

Shandra Bipat, PhD

Jaap Stoker, MD, PhD

Institution:

Department of Radiology

Academic Medical Center

University of Amsterdam

Meibergdreef 9

1105 AZ Amsterdam

The Netherlands

ESM 8: CT accuracy

Steatosis on biopsy / Study / Cut-off / Disease present / Disease not present / Sensitivity (%) / Specificity (%)
TP / FN / FP / TN
>0% / Cho 2008 / L-S ≤ -10HUe / 2 / 17 / 0 / 7 / 10.5 / 100
Cho 2008 / Visual evaluationc / 4 / 15 / 0 / 6 / 21.1 / 100
Cho 2008 / L-S ≤ -43HUb,e / 13 / 36 / 4 / 22 / 26.5 / 84.6
Cho 2008 / Visual evaluationb,c / 18 / 28 / 5 / 21 / 39.1 / 80.8
>5% / Limanond 2004 / L-S ≤ 5 HUd / 13 / 2 / 2 / 25 / 86.7 / 92.6
Lee JY 2007 / L-S ≤ -10HUe / 85 / 216 / 6 / 279 / 28.2 / 97.9
Kim DY 2009 / L-S ≤ -6 HUb,d / 29 / 39 / 11 / 100 / 42.6 / 90.1
Kim DY 2009 / L-B ≤ 104 HUb,d / 45 / 23 / 15 / 96 / 66.2 / 86.5
Summary estimates (±95% CI)f / 53.9 (22.3-82.7) / 88.7 (84.4-91.9)
>10% / Yoshimitsu 2008 / L-S ≤ 6 HUd / - / - / - / - / 94 / 75
Kim DY 2009 / L-S ≤ -6 HUb,d / 25 / 24 / 15 / 115 / 51.0 / 88.5
Kim DY 2009 / L-B ≤ 101 HUb,d / 33 / 16 / 18 / 112 / 67.3 / 86.2
Tobari 2009 / L/S ≤ 0.9e / 55 / 63 / - / - / 46.6 / -
Yamashiki 2009 / L/S ≤ 1.1e / 6 / 3 / 4 / 65 / 66.7 / 94.2
>15% / Kim DY 2009 / L-S ≤ -4 HUb,d / 20 / 9 / 35 / 115 / 69.0 / 76.7
Kim DY 2009 / L-B ≤94 HUb,d / 18 / 11 / 14 / 136 / 62.1 / 90.7
>20% / Kim DY 2009 / L-S ≤ -10 HUb,d / 12 / 8 / 16 / 143 / 60.0 / 89.9
Kim DY 2009 / L-B ≤ 92 HUb,d / 15 / 5 / 11 / 148 / 75.0 / 93.1
Summary estimates (±95% CI)f / 62.9 (56.1-69.3) / 88.1 (81.1-92.7)
>25% / Kim DY 2009 / L-S ≤ -10 HUb,d / 11 / 5 / 17 / 146 / 68.8 / 89.6
Kim DY 2009 / L-B ≤ 92 HUb,d / 14 / 2 / 12 / 151 / 87.5 / 92.6
>30% / Rinella 2001 / ND / 1 / 4 / 0 / 13 / 20.0 / 100
Iwasaki 2004 / L/S ≤ 1.1d / 15 / 3 / 46 / 202 / 83.3 / 81.5
Limanond 2004 / L-S ≤ -10 HUd / 4 / 0 / 0 / 38 / 100 / 100
Cho 2008 / L-S ≤ -10HUe / 3 / 3 / 1 / 18 / 50.0 / 94.7
Cho 2008 / Visual evaluation (moderate or severe)c / 2 / 4 / 0 / 20 / 33.3 / 100
Cho 2008 / L-S ≤ -43HUb,e / 8 / 5 / 15 / 44 / 61.5 / 74.6
Cho 2008 / Visual evaluation (moderate or severe)b, c / 7 / 7 / 10 / 50 / 50.0 / 83.3
Park 2006 / L/S ≤ 0.9 HUd / 10 / 1 / 5 / 138 / 90.9 / 96.5
Park 2006 / L-S ≤ -7 HUd / 10 / 1 / 1 / 142 / 90.9 / 99.3
Park 2006 / LP 58d / 11 / 0 / 7 / 136 / 100 / 95.1
Lee JY 2007 / L-S ≤ -10 HUe / 41 / 23 / 50 / 472 / 64.1 / 90.4
Lee SW 2007 / L-S ≤ -14 HUd / 12 / 12 / 0 / 24 / 50.0 / 100
Lee SW 2007 / Visual evaluationc / 10 / 14 / 1 / 23 / 41.7 / 95.8
Yoshimitsu 2008 / L-S ≤ -8 HUd / 10 / 5 / 0 / 39 / 66.7 / 100
Kim DY 2009 / L-S ≤ -19 HUb,d / 9 / 4 / 7 / 159 / 69.2 / 95.8
Kim DY 2009 / L-B ≤ 92 HUb,d / 11 / 2 / 15 / 151 / 84.6 / 91.0
>33% / Saadeh 2002 / L-S/visual: “markedly” reduced liver attenuation / - / - / - / - / 93 / -
Summary estimates (±95% CI)f / 73.3 (58.9-84.1) / 95.6 (87.7-98.5)

Note.— ND: Not defined; HU: Hounsfield Units; L-S: Liver minus spleen attenuation value; L/S: Liver/spleen attenuation ratio; L-B: Blood subtracted hepatic attenuation; LP: Blood-free hepatic parenchymal attenuation: [L- 0,3*(0,75P+0,25A)]/0,7 (L: Liver parenchyma attenuation; P: Portal venous blood attenuation; A: Hepatic arterial blood attenuation); CI: Confidence interval.

aUnenhanced CT unless noted otherwise

bContrast-enhanced CT

cVisually evaluated data were not included in analysis

dCut-off value was defined by analysis of study results; the optimal cut-off value is included in this table and was used for analysis.

eCut-off value was defined before the study

fSummary estimates did not include visual evaluation scores