Objective: This study aimed to comprehensively assess the diagnostic accuracy of point shear wave elastography (pSWE) and vibration-controlled transient elastography (VCTE) in paediatric metabolic dysfunction-associated steatotic liver disease (MASLD).

Methods: Systematic review and meta-analysis of diagnostic test accuracy using the Grading of Recommendations Assessment, Development and Evaluation approach with random-effects models. Methods: PubMed, Embase, Web of Science, Ovid (Medline), Cochrane, China National Knowledge Infrastructure, Wan Fang and OpenGrey were searched for publications from April 1989 to July 2024. Methods: The study included relevant records on the application of pSWE and VCTE in diagnosing MASLD in children (<19 years). These studies evaluated the diagnostic performance (sensitivity, specificity, area under the receiver operating characteristic curve) of two techniques for paediatric MASLD in the context of a relative gold standard with no language barriers. Studies of children with concurrent liver diseases were excluded. Methods: Two independent reviewers extracted data and assessed the risk of bias. Articles were assessed using Quality Assessment of Diagnostic Accuracy Studies 2 for diagnostic accuracy and potential biases, and bias risks were visually represented using the Risk of Bias Visualisation tool. Heterogeneity was assessed (Cochran Q statistic) and quantified (I2 statistic). The analysis of the likelihood ratio graph (Fagan plot) indicates that both pSWE and VCTE provide valuable diagnostic support for MASLD.

Results: The comprehensive literature search yielded four pSWE studies encompassing 968 children and seven VCTE studies encompassing 1934 children. In our meta-analysis, VCTE had a sensitivity of 0.89 (95% CI, 0.79 to 0.94) and a specificity of 0.90 (95% CI, 0.83 to 0.95), which showed superior diagnostic accuracy compared with pSWE (sensitivity, 0.89 (95% CI, 0.81 to 0.94); specificity, 0.85 (95% CI, 0.81 to 0.89)).

Conclusions: While both pSWE and VCTE demonstrated appreciable diagnostic efficacy in paediatric MASLD, VCTE showed similar sensitivity but superior specificity, emerging as the more effective technique particularly in non-obese children. However, further investigation is warranted to fully elucidate the influence of probe selection and racial prevalence on these diagnostic modalities. CRD42024514246.