Volume 134, Issue 4, Pages 960-974.e8 (April 2008) Performance of Transient Elastography for the Staging of Liver Fibrosis: A Meta- Analysis  Mireen Friedrich–Rust, Mei–Fang Ong, Swantje Martens, Christoph Sarrazin, Joerg Bojunga, Stefan Zeuzem, Eva Herrmann  Gastroenterology  Volume 134, Issue 4, Pages 960-974.e8 (April 2008) DOI: 10.1053/j.gastro.2008.01.034 Copyright © 2008 AGA Institute Terms and Conditions

Figure 1 Forest plot from meta-analysis of AUROC values using a random-effects model for fibrosis stages (A) F ≤ 1 vs F ≥ 2, (B) F ≤ 2 vs F ≥ 3, and (C) F ≤ 3 vs F = 4. The distribution is shown according to the sample size. The length of the horizontal line represents the 95% CI, ●, AUROC of the studies examining HCV-infected patients only, ■, AUROC of the studies examining a patient population of different liver diseases including HCV, ▲, AUROC of the studies without HCV patients, and ♦, overall mean AUROC with 95% confidence bounds. Gastroenterology 2008 134, 960-974.e8DOI: (10.1053/j.gastro.2008.01.034) Copyright © 2008 AGA Institute Terms and Conditions

Figure 2 The AUROC according to DANA. The size of the dots is derived from the respective DerSimonian and Laird11 type of weights for each study and the line showed a meta-regression fit. Gastroenterology 2008 134, 960-974.e8DOI: (10.1053/j.gastro.2008.01.034) Copyright © 2008 AGA Institute Terms and Conditions

Figure 3 (A) SROC for F ≥ 2, (B) F ≥ 3, and (C) F = 4. The size of the dots for 1-specificity and sensitivity of the single studies in the ROC space is derived from the respective sample size. (D) SROC curves for different fibrosis stages are compared shown in the right lower panel. (A–C) •, HCV; ■, mixed diagnosis; ▾, no HCV. (D) —, Diagnosis of significant fibrosis; – – –, diagnosis of severe fibrosis; - - -, diagnosis of cirrhosis. Gastroenterology 2008 134, 960-974.e8DOI: (10.1053/j.gastro.2008.01.034) Copyright © 2008 AGA Institute Terms and Conditions

Figure 4 Sensitivity and specificity of respective cut-off values of the single studies for (A and D) F ≥ 2, (B and E) F ≥ 3, and (C and F) F = 4. The size of the dots is derived from the sample size of the single studies. Furthermore, the regression line with respect to a corresponding weighted linear regression is shown. The vertical line is drawn by calculation of the optimal sensitivity and specificity from the SROC. The crossing of both lines suggests the optimal cut-off value (F ≤ 1 vs F ≥ 2, 7.65 kPa; F ≤ 3 vs F = 4, 13.01 kPa). Gastroenterology 2008 134, 960-974.e8DOI: (10.1053/j.gastro.2008.01.034) Copyright © 2008 AGA Institute Terms and Conditions

Figure 5 Proportion of studies rated as yes, no, or unclear for each of the QUADAS items. In the columns on the right it is indicated for each QUADAS item if a significant reduction of heterogeneity for the AUROC can be shown. Gastroenterology 2008 134, 960-974.e8DOI: (10.1053/j.gastro.2008.01.034) Copyright © 2008 AGA Institute Terms and Conditions