{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T13:29:55Z","timestamp":1791379795580,"version":"4.3.3"},"reference-count":216,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2025,6,24]],"date-time":"2025-06-24T00:00:00Z","timestamp":1750723200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"University of Alberta Summer Student Research Award (Shyam Mehta)"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Objectives: To compare thresholds and accuracies of FIB-4, vibration-controlled transient elastography (VCTE), point shear wave elastography (pSWE), 2D shear wave elastography (2D-SWE), and MR elastography (MRE) for detecting hepatic fibrosis in patients with MASLD. Materials and Methods: Systematic searching of MEDLINE, EMBASE, Cochrane Library, Scopus, and the gray literature from inception to March 2024 was performed. Studies evaluating accuracies of FIB-4, VCTE, 2D-SWE, pSWE, and\/or MRE for detecting significant (\u2265F2) and\/or advanced (\u2265F3) hepatic fibrosis in MASLD patients compared to histology were identified. Full-text review and data extraction were performed independently by two reviewers. Multivariate meta-analysis and subgroup analyses were performed using index test and fibrosis grading. Risk of bias was assessed using QUADAS-2. Results: 207 studies with over 80,000 patient investigations were included. FIB-4 1.3 threshold sensitivity was 71% (95% CI 66\u201375%) for detecting advanced hepatic fibrosis, which improved to 88% (85\u201391%) using a &lt;0.75 threshold. FIB-4 specificity using a 2.67 threshold was 96% (94\u201397%). Sensitivities of 88\u201391% were achieved using thresholds of 3.2 kPa for pSWE, 4.92 kPa for 2D-SWE, 7.18 kPa for VCTE, and 2.32 kPa for MRE. No significant differences were identified for sensitivities in subgroup analysis with thresholds between 7 and 9 kPa. Most imaging-based studies were high risk of bias for the index test. Conclusions: A FIB-4 threshold of &lt;0.75 and modality-dependent thresholds (VCTE &lt; 7 kPa; pSWE &lt;3 kPa; 2D-SWE &lt;5 kPa; and MRE &lt;2.5 kPa) would achieve sensitivities of around 90% when defining low-risk MASLD in population screening. A modified two-tier algorithm aligning with existing Society of Radiologists in Ultrasound guidelines would improve risk stratification accuracies compared to existing guidelines by European and American liver societies.<\/jats:p>","DOI":"10.3390\/diagnostics15131598","type":"journal-article","created":{"date-parts":[[2025,6,24]],"date-time":"2025-06-24T08:50:57Z","timestamp":1750755057000},"page":"1598","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Comparing FIB-4, VCTE, pSWE, 2D-SWE, and MRE Thresholds and Diagnostic Accuracies for Detecting Hepatic Fibrosis in Patients with MASLD: A Systematic Review and Meta-Analysis"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1630-5138","authenticated-orcid":false,"given":"Mitchell Patrick","family":"Wilson","sequence":"first","affiliation":[{"name":"Department of Radiology and Diagnostic Imaging, University of Alberta, 8440-112 Street NW, Edmonton, AB T6G 2B7, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ranjit","family":"Singh","sequence":"additional","affiliation":[{"name":"Department of Radiology and Diagnostic Imaging, University of Alberta, 8440-112 Street NW, Edmonton, AB T6G 2B7, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shyam","family":"Mehta","sequence":"additional","affiliation":[{"name":"Department of Radiology and Diagnostic Imaging, University of Alberta, 8440-112 Street NW, Edmonton, AB T6G 2B7, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad Hassan","family":"Murad","sequence":"additional","affiliation":[{"name":"Evidence-Based Practice Center, Mayo Clinic, Rochester, MN 55905, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7516-8631","authenticated-orcid":false,"given":"Christopher","family":"Fung","sequence":"additional","affiliation":[{"name":"Department of Radiology and Diagnostic Imaging, University of Alberta, 8440-112 Street NW, Edmonton, AB T6G 2B7, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4959-8934","authenticated-orcid":false,"given":"Gavin","family":"Low","sequence":"additional","affiliation":[{"name":"Department of Radiology and Diagnostic Imaging, University of Alberta, 8440-112 Street NW, Edmonton, AB T6G 2B7, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,6,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"492","DOI":"10.1016\/j.jhep.2024.04.031","article-title":"EASL\u2013EASD\u2013EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD)","volume":"81","author":"Tacke","year":"2024","journal-title":"J. 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