***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background Simple and inexpensive non-invasive fibrosis tests are highly needed but have been poorly studied in sub-Saharan Africa . Methods Using liver histology as a gold st and ard , we developed a novel index using routine laboratory tests to predict significant fibrosis in patients with chronic HBV infection in The Gambia , West Africa . We prospect ively assessed the diagnostic accuracy of the novel index , Fibroscan , aspartate transaminase-to-platelet ratio index ( APRI ) , and Fib-4 in Gambian patients with CHB ( training set ) and also in French and Senegalese CHB cohorts ( validation sets ) . Results Of 135 consecutive treatment-naïve patients with CHB who had liver biopsy , 39 % had significant fibrosis ( Metavir fibrosis stage ≥F2 ) and 15 % had cirrhosis ( F4 ) . In multivariable analysis , gamma-glutamyl transpeptidase ( GGT ) and platelet count were independent predictors of significant fibrosis . Consequently , GGT-to-platelet ratio ( GPR ) was developed . In The Gambia , the area under the receiver operating characteristic curve ( AUROC ) of the GPR was significantly higher than that of APRI and Fib-4 to predict ≥F2 , ≥F3 and F4 . In Senegal , the AUROC of GPR was significantly better than Fib-4 and APRI for ≥F2 ( 0.73 , 95 % CI 0.59 to 0.86 ) and better than Fib-4 and Fibroscan for ≥F3 ( 0.93 , 0.87 to 0.99 ) . In France , the AUROC of GPR to diagnose ≥F2 ( 0.72 , 95 % CI 0.59 to 0.85 ) and F4 ( 0.87 , 0.76 to 0.98 ) was equivalent to that of APRI and Fib-4 . Conclusions The GPR is a more accurate routine laboratory marker than APRI and Fib-4 to stage liver fibrosis in patients with CHB in West Africa . The GPR represents a simple and inexpensive alternative to liver biopsy and Fibroscan in sub-Saharan Africa Objective To compare several noninvasive indices of fibrosis in chronic viral hepatitis B , including liver shear-wave velocity ( SWV ) , hyaluronic acid ( HA ) , collagen type IV ( CIV ) , procollagen type III ( PCIII ) , and laminin ( LN ) . Material s and Methods Acoustic radiation force impulse ( ARFI ) was performed in 157 patients with chronic viral hepatitis B and in 30 healthy volunteers to measure hepatic SWV ( m/s ) in a prospect i ve study . Serum markers  were acquired on the morning of the same day of the ARFI evaluation . Receiver operating characteristic ( ROC ) analysis was performed to evaluate and compare the accuracies of SWV and serum markers using METAVIR scoring from liver biopsy as a reference st and ard . Results The most accurate test for diagnosing fibrosis F ≥ 1 was SWV with the area under the ROC curve ( AUC ) of 0.913 , followed by LN ( 0.744 ) , HA ( 0.701 ) , CIV ( 0.690 ) , and PCIII ( 0.524 ) . The best test for diagnosing F ≥ 2 was SWV ( AUC of 0.851 ) , followed by CIV ( 0.671 ) , HA ( 0.668 ) , LN ( 0.562 ) , and PCIII ( 0.550 ) . The best test for diagnosing F ≥ 3 was SWV ( 0.854 ) , followed by CIV ( 0.693 ) , HA ( 0.675 ) , PCIII ( 0.591 ) , and LN ( 0.548 ) . The best test for diagnosing F = 4 was SWV ( 0.965 ) , followed by CIV ( 0.804 ) , PCIII ( 0.752 ) , HA ( 0.744 ) , and LN ( 0.662 ) . SWV combined with HA and CIV did not improve diagnostic accuracy ( AUC = 0.931 for F ≥ 1 , 0.863 for F ≥ 2 , 0.855 for F ≥ 3 , 0.960 for F = 4 ) . Conclusion The performance of SWV in diagnosing liver fibrosis is superior to that of serum markers . However , the combination of SWV , HA , and CIV does not increase the accuracy of diagnosing liver fibrosis and cirrhosis Objectives We measured the accuracy of magnetic resonance elastography ( MRE ) for the detection and staging of liver fibrosis in chronic hepatitis B ( CHB ) and compared it with serum fibrosis markers . Methods Prospect i ve comparison of MRE and routine serum fibrosis markers , namely serum alanine aminotransferase ( ALT ) , serum aspartate aminotransferase ( AST ) , ALT/AST ratio ( AAR ) , AST to platelet ratio index ( APRI ) and prothrombin index ( PI ) , was performed in 63 consecutive CHB patients who underwent MRE and histological confirmation of liver fibrosis within a 6-month interval . Diagnostic performance of MRE and serum markers for staging fibrosis ( ≥F1 ) , significant fibrosis ( ≥F2 ) , advanced fibrosis ( ≥F3 ) and cirrhosis ( F4 ) was compared . Results The study group comprised 63 patients ( 19 female ; mean age ± SD , 50 ± 11.9 years ) . MRE ( ρ = 0.94 , P < 0.0001 ) , APRI ( ρ = 0.42 , P = 0.0006 ) , PI ( ρ = 0.42 , P = 0.0006 ) and AST ( ρ = 0.28 , P = 0.028 ) results correlated significantly with fibrosis stage . MRE was significantly more accurate than serum fibrosis markers for the detection of significant fibrosis ( 0.99 vs. 0.55–0.73 ) and cirrhosis ( 0.98 vs. 0.53–0.77 ) . Sensitivity , specificity , positive predictive and negative predictive values for MRE for significant fibrosis and cirrhosis were 97.4 % , 100 % , 100 % and 96 % , and 100 % , 95.2 % , 91.3 % and 100 % , respectively . Conclusion MRE is an accurate non-invasive technique for the detection and staging of liver fibrosis in CHB.Key Points• Magnetic resonance elastography is accurate for liver fibrosis detection and staging.• MR elastography is more accurate than serum tests for staging liver fibrosis.• MR elastography can potentially replace liver biopsy in chronic hepatitis BACKGROUND / AIMS Accuracy of transient elastography ( TE ) in hepatitis B virus ( HBV ) infection has not been well established . We aim ed to compare the performances of TE for the assessment of  liver fibrosis in patients with chronic HBV or hepatitis C virus ( HCV ) infection . A secondary analysis was performed to assess whether or not alanine aminotransferase ( ALT ) levels would impact on the accuracy of TE . METHODS This cross-sectional study , carried out in a single centre , included treatment-naïve patients with compensated chronic HBV or HCV infection , consecutively admitted between 2006 and 2008 for a liver biopsy and TE measurement on the same day . RESULTS A total of 202 HBV patients and 363 HCV subjects were evaluated .  Overall diagnostic accuracy of TE in the HBV group was comparable to that observed in HCV patients [ area under the receiver-operating characteristics ( AUROCs ) 0.867 ± 0.026 vs. 0.868 ± 0.019 for predicting F ≥ 2 , P = 0.975 ; 0.902 ± 0.029 vs. 0.894 ± 0.020 for F ≥ 3 , P = 0.820 ; and 0.935 ± 0.024 vs. 0.947 ± 0.027 for F4 , P = 0.740 respectively ] . TE exhibited comparable accuracies , sensitivities , specificities , predictive values and likelihood ratios in HBV and HCV groups . AUROC analysis showed no influence of ALT levels on the performance of TE in HBV individuals . ALT-specific cut-off values did not exhibit significantly higher diagnostic performances for predicting fibrosis in HBV patients with elevated ALT . CONCLUSIONS In HBV patients , TE measurement accurately predicts the absence or presence of significant fibrosis , advanced fibrosis or cirrhosis and shows similar performances as compared to HCV patients . The use of TE cut-off values adjusted to ALT level did not improve performances for estimating liver  fibrosis in HBV patients Objective We aim ed to evaluate the performance of the newly developed deep learning Radiomics of elastography ( DLRE ) for assessing liver fibrosis stages .  DLRE adopts the radiomic strategy for quantitative analysis of the heterogeneity in two-dimensional shear wave elastography ( 2D-SWE ) images . Design A prospect i ve multicentre study was conducted to assess its accuracy in patients with chronic hepatitis B , in comparison with 2D-SWE , aspartate transaminase-to-platelet ratio index and fibrosis index based on four factors , by using liver biopsy as the reference st and ard . Its accuracy and robustness were also investigated by applying different number of acquisitions and different training cohorts , respectively . Data of 654 potentially eligible patients were prospect ively enrolled from 12 hospitals , and finally 398 patients with 1990 images were included . Analysis of receiver operating characteristic ( ROC ) curves was performed to calculate the optimal area under the ROC curve ( AUC ) for cirrhosis ( F4 ) , advanced fibrosis ( ≥F3 ) and significance fibrosis ( ≥F2 ) . Results AUCs of DLRE were 0.97 for F4 ( 95 % CI 0.94 to 0.99 ) , 0.98 for ≥F3 ( 95 % CI 0.96 to 1.00 ) and 0.85 ( 95 % CI 0.81 to 0.89 ) for ≥F2 , which were significantly better than other methods except 2D-SWE in ≥F2 . Its diagnostic accuracy improved as more images ( especially ≥3 images ) were acquired from each individual . No significant variation of the performance was found if different training cohorts were applied . Conclusion DLRE shows the best overall performance in predicting liver fibrosis stages compared with 2D-SWE and biomarkers . It is valuable and practical for the non-invasive accurate diagnosis of liver fibrosis stages in HBV-infected patients . Trial registration number NCT02313649 ; Post- results Background and Aims Liver stiffness measurement ( LSM ) and FibroTest ( FT ) are frequently used as non-invasive alternatives for fibrosis staging to liver biopsy . However , to date , diagnostic performances of Enhanced Liver Fibrosis ( ELF ) test , which consists of hyaluronic acid , aminoterminal propeptide of procollagen type-III , and tissue inhibitor of matrix metalloproteinases-1 , have not been compared to those of LSM and FT in Asian chronic hepatitis B ( CHB ) patients . Methods Between June 2010 and November 2011 , we prospect ively enrolled 170 CHB patients who underwent liver biopsies along with LSM , FT , and ELF .  The Batts system was used to assess fibrosis stages . Results Areas under receiver operating characteristic curves ( AUROCs ) to predict significant fibrosis ( F≥2 ) , advanced fibrosis ( F≥3 ) , and cirrhosis ( F = 4 ) were 0.901 , 0.860 , and 0.862 for ELF , respectively ; 0.937 , 0.956 , and 0.963 for LSM ; and 0.896 , 0.921 , and 0.881 for FT . AUROCs to predict F≥2 were similar between each other , whereas LSM and FT had better AUROCs than ELF for predicting F≥3 ( both p<0.05 ) , and LSM predicted F4 more accurately than ELF ( p<0.05 ) . Optimized cutoffs of ELF to maximize sum of sensitivity and specificity were 8.5 , 9.4 , and 10.1 for F≥2 , F≥3 , and F = 4 , respectively . Using suggested ELF , LSM and FT cutoffs to diagnose F1 , F2 , F3 , and F4 , 91 ( 53.5 % ) , 117 ( 68.8 % ) , and 110 ( 64.7 % ) patients , respectively , were correctly classified according to histological results . Conclusions ELF demonstrated considerable diagnostic value in fibrosis staging in Asian CHB patients , especially in predicting F≥2 . However , LSM consistently provided better performance for predicting F≥3 and F4 Background and Aims Diagnostic values of FibroTest ( FT ) for hepatic fibrosis have rarely been assessed in Asian chronic hepatitis B ( CHB ) patients . We aim ed to vali date its diagnostic performances in comparison with liver stiffness ( LS ) . Methods 
    Output:
    
The publication bias was not observed in any of the serum biomarkers or imaging methods .
These five methods have attained an acceptable level of diagnostic accuracy .
Imaging techniques , MRE in particular , demonstrate significant advantages in accurately predicting HBV-related significant fibrosis , while serum biomarkers are admissible methods