Diagnostic accuracy of hepatic proton density fat fraction measured by magnetic resonance imaging for the evaluation of liver steatosis with histology as reference standard: a meta-analysis

  • Yali Qu
  • Mou Li
  • Gavin Hamilton
  • Yingzhen N. Zhang
  • Bin SongEmail author
Magnetic Resonance



The aim of this meta-analysis was to evaluate the diagnostic accuracy of hepatic magnetic resonance imaging-proton density fat fraction (MRI-PDFF) for the assessment of liver steatosis (LS) with histology as reference standard.


A systematic literature search was performed to identify pertinent studies. Quality analyses were conducted by Quality Assessment of Diagnostic Accuracy Studies-2. Diagnostic data were extracted and inconsistency index was calculated for LS≥G1, LS≥G2, and LS=G3, respectively. The area under summary receiver operating characteristic curve (AUC) served as the indicator of diagnostic accuracy. The pooled sensitivity and specificity were calculated if threshold effect was absent.


Thirteen studies containing 1100 subjects were included. There was significant threshold effect for LS≥G1. The AUCs for LS≥G1, LS≥G2, and LS=G3 were 0.98 (95% confidence interval (CI) 0.76, 1.00), 0.91 (95% CI 0.89, 0.94), and 0.92 (95% CI 0.89, 0.94), respectively. The pooled sensitivities for LS≥G2 and LS=G3 were 0.83 (95% CI 0.75, 0.88) and 0.79 (95% CI 0.63, 0.90), respectively; the pooled specificities for LS≥G2 and LS=G3 were 0.89 (95% CI 0.84, 0.92) and 0.89 (95% CI 0.84, 0.92), respectively.


MRI-PDFF has high diagnostic accuracy at detecting and grading LS with histology as reference standard, suggesting that MRI-PDFF is able to provide an accurate quantification of LS in clinical trials and patient care.

Key Point

MRI-PDFF is able to provide an accurate quantification of LS in clinical trials and patient care.


Fatty liver Magnetic resonance imaging Area under curve Meta-analysis 



Area under summary receiver operating characteristic curve


Confidence interval


Chemical shift–encoded magnetic resonance imaging


False negative


False positive


Liver steatosis


Medical Subject Headings


Magnetic resonance spectroscopy


Nonalcoholic fatty liver disease


Nonalcoholic steatohepatitis


Proton density fat fraction






Summary receiver operating characteristic


True negative


True positive



This study has received funding by the National Natural Science Foundation of China, No. 81471658.

Compliance with ethical standards


The scientific guarantor of this publication is Bin Song.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was not required for this study because this study is based on the published studies to perform the meta-analysis.

Ethical approval

Institutional Review Board approval was not required because this study is based on the published studies to perform data analysis.


• retrospective

• diagnostic or prognostic study

• performed at one institution

Supplementary material

330_2019_6071_MOESM1_ESM.docx (45 kb)
ESM 1 (DOCX 44 kb)


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Copyright information

© European Society of Radiology 2019

Authors and Affiliations

  1. 1.Department of RadiologyWest China Hospital of Sichuan UniversityChengduChina
  2. 2.Liver Imaging Group, Department of RadiologyUniversity of California at San DiegoLa JollaUSA

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