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US Markers and Necroinflammation, Steatosis, and Fibrosis in Metabolic Dysfunction-associated Steatotic Liver
Katsutoshi Sugimoto1, Fuminori Moriyasu1, Marco Dioguardi Burgio1
1From the Department of Gastroenterology and Hepatology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan (K. Sugimoto, T.I.); Department of Gastroenterology and Hepatology, International University of Health and Welfare, Sanno Hospital, Tokyo, Japan (F.M.); Department of Radiology, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Clichy, France (M.D.B., V.V.); Departments of Internal Medicine 1, Medicine 1, Gastroenterology, Endocrinology, and Pneumology, Erlangen University Hospital, Erlangen, Germany (D.J., D.S.); Division of Gastroenterology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany (V.B., T.K.); Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, Calif (E.G.G.); Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Ill (L.C.K., H.G.); Department of Radiology, Chung-Ang University Hospital, Seoul, Korea (B.I.C.); Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan (T.N., H.I.); Department of Radiology, University of Washington, Seattle, Wash (T.J.D.); Rocky Vista University, Ivins, Utah (J.G.); Department of Radiology, Seoul National University Hospital, Seoul, Korea (D.H.L., J.Y.L.); Department of Ultrasound in Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China (Y.Z., P.H.); Department of Ultrasound, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (J.Z.); Department of Imaging, Charing Cross Hospital, Imperial College London and Imperial College Healthcare NHS Trust, London, England (A.L.); Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (X.X.); Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio (R.G.B.); Southwoods Imaging, Youngstown, Ohio (R.G.B.); Division of Internal-Surgical Ultrasound, Department of Radiologic, Oncologic, and Anatomic-Pathologic Science, Polyclinic Umberto I, Sapienza University of Rome, Rome, Italy (V.C.); Department of Clinical-Surgical, Diagnostic, and Pediatric Sciences, Medical School, University of Pavia, Pavia, Italy (G.F.); Center for Data Science, Juntendo University, Tokyo, Japan (K. Sakamaki); and Department of Pathology, Kurume University School of Medicine, Kurume, Japan (M.K., H.Y.).
Abstract:
Background Attenuation coefficient (AC) and shear-wave speed (SWS) are established US markers for assessing patients with metabolic dysfunction-associated steatotic liver disease (MASLD), while shear-wave dispersion slope (DS) is not. Purpose To assess the relationship between the multiparametric US imaging markers DS, AC, and SWS and liver histopathologic necroinflammation in patients with MASLD. Materials and Methods This international multicenter prospective study enrolled consecutive patients with biopsy-proven MASLD between June 2019 and March 2023. Before biopsy, all participants underwent multiparametric US, and measurements of DS, AC, and SWS were obtained. Multivariable linear regression analyses were performed to assess the association of clinical variables and imaging markers with pathologic findings. The diagnostic performance of imaging markers for determining inflammation grade, steatosis grade, and fibrosis stage was assessed using the area under the receiver operating characteristic curve (AUC). Results A total of 124 participants (mean age, 53 years ± 15 [SD]; 62 males) were evaluated. In multivariable regression, lobular inflammation was associated with DS (regression coefficient, 0.06; P = .02), alanine aminotransferase level (regression coefficient, 0.002; P = .002), and Hispanic or Latino ethnicity (regression coefficient, -0.68; P = .047), while steatosis was associated with AC (regression coefficient, 3.66; P < .001) and fibrosis was associated with SWS (regression coefficient, 2.02; P < .001) and body mass index (regression coefficient, 0.05; P = .02). DS achieved an AUC of 0.72 (95% CI: 0.63, 0.82) for identifying participants with inflammation grade A2 or higher (moderate to severe inflammation). AC showed excellent performance for identifying participants with grade S1 (mild) or higher steatosis (AUC, 0.92 [95% CI: 0.87, 0.97]), while SWS showed excellent performance for identifying participants with fibrosis stage F2 or higher (clinically significant fibrosis) (AUC, 0.91 [95% CI: 0.86, 0.96]). Of the three US markers, SWS showed the highest AUC (0.81 [95% CI: 0.74, 0.89]) for the diagnosis of metabolic dysfunction-associated steatohepatitis. Conclusion Of the three US imaging markers (DS, AC, and SWS), DS was most associated with lobular inflammation grade at histologic examination and demonstrated fair diagnostic performance in distinguishing moderate to severe lobular inflammation. ClinicalTrials.gov Identifier: NCT04012242 Published under a CC BY 4.0 license. Supplemental material is available for this article. See also the editorial by Yin in this issue.
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