Clinical utility of acoustic radiation force impulse imaging for identification of malignant liver lesions: a meta-analysis

Objectives To assess the performance of acoustic radiation force impulse (ARFI) imaging for identification of malignant liver lesions using meta-analysis. Methods PubMed, the Cochrane Library, the ISI Web of Knowledge and the China National Knowledge Infrastructure were searched. The studies published in English or Chinese relating to evaluation accuracy of ARFI imaging for identification of malignant liver lesions were collected. A hierarchical summary receiver operating characteristic (HSROC) curve was used to examine the ARFI imaging accuracy. Clinical utility of ARFI imaging for identification of malignant liver lesions was evaluated by Fagan plot analysis. Results A total of eight studies which included 590 liver lesions were analysed. The summary sensitivity and specificity for identification of malignant liver lesions were 0.86 (95 % confidence interval (CI) 0.74–0.93) and 0.89 (95 % CI 0.81–0.94), respectively. The HSROC was 0.94 (95 % CI 0.91–0.96). After ARFI imaging results over the cut-off value for malignant liver lesions (“positive” result), the corresponding post-test probability for the presence (if pre-test probability was 50 %) was 89 %; in “negative” measurement, the post-test probability was 13 %. Conclusions ARFI imaging has a high accuracy in the classification of liver lesions. Key Points • Acoustic radiation force impulse (ARFI) imaging is a novel ultrasound-based elastography method. • This study comprehensively assessed the published performance of ARFI for liver lesions. • ARFI imaging appears to have high sensitivity and specificity for liver lesions. • ARFI can help differentiate liver lesions and may prevent unnecessary biopsies.