Selvaraj EA, Mózes FE, Jayaswal ANA, et al. - In this systematic review and meta-analysis, researchers sought to evaluate the diagnostic performances of elastography and MRI index tests for the assessment of liver fibrosis and non-alcoholic steatohepatitis (NASH) in patients with non-alcoholic fatty liver disease (NAFLD). The sample consisted of 14,609 patients. Meta-analysis was possible for diagnosing fibrosis stages in 53 vibration-controlled transient elastography (VCTE), 11 magnetic resonance elastography (MRE), 12 point shear wave elastography (pSWE), and four two-dimensional shear wave elastography (2DSWE) studies, as well as for diagnosing NASH in four MRE studies. VCTE, MRE, pSWE, and 2DSWE have good diagnostic accuracy for fibrosis assessment in patients with NAFLD where liver stiffness can be measured successfully, but only MRE and pSWE meet the minimum acceptable criteria of at least 80% sensitivity and specificity for the diagnosis of advanced fibrosis. However, because intention-to-diagnose analyses and validation of pre-specified cut-offs are lacking in the literature, these promising results are likely to overestimate true diagnostic accuracy.