Diagnostic Performance of SWE and Predictive Models Based on SWE for Post- Hepatectomy Liver Failure: A Systematic Review and Meta-analysis.

Background: Post-hepatic resection liver failure (PHLF) remains one of the most serious complications after hepatic resection, with an overall morbidity rate as high as 32% and an approximate 5% mortality. Previous studies demonstrate the potential of shear wave elastography (SWE) to predict PHLF. This meta-analysis aimed to evaluate the diagnostic accuracy of SWE in identifying liver failure after hepatectomy.

Methods: A comprehensive search was performed across PubMed/Medline, Embase, and Web of Science to identify studies assessing the diagnostic accuracy of SWE for predicting PHLF. The combined sensitivity, specificity, and the hierarchical summary receiver operating characteristic curve (HSROC) for SWE in detecting PHLF in liver resection patients. The Quality Assessment of Diagnostic Accuracy Studies tool was used to evaluate the quality of the studies included in the analysis. Heterogeneity was explored through sensitivity analysis, univariable meta-regression and subgroup analysis.

Results: This meta-analysis included a total of 13 studies involving 2985 patients. For quantitative analysis. The combined sensitivities and specificities of SWE for detecting post-hepatectomy liver failure were 0.81 and 0.68, respectively. The HSROC value for SWE was 0.82. Significant heterogeneity (I² = 80.22) was observed in pooled specificity. Meta-regression and subgroup analyses suggest that differences in the proportion of patients with HCC and in the diagnostic criteria for PHLF may account for the observed heterogeneity. For the qualitative analysis, six predictive models based on SWE were included, and their AUCs were 0.80-0.915.

Conclusion: Both SWE alone and SWE-based prediction models appear to accurately detect PHLF and help to categorize patients into high- and low-risk groups. It may also assist surgeons in identifying the best candidates for liver resection and enhancing perioperative management.