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Identification of Candidates for MASLD Treatment With Indeterminate Vibration-Controlled Transient Elastography
David Marti-Aguado1, José Miguel Carot-Sierra2, Aida Villalba-Ortiz2
1Digestive Disease Department, Clinic University Hospital, INCLIVA Health Research Institute, Valencia, Spain; Biomedical Imaging Research Group (GIBI2(30)), La Fe Health Research Institute, Valencia, Spain; Imaging La Fe Node, Distributed Network for Biomedical Imaging Unique Scientific and Technical Infrastructures, Valencia, Spain.
A new algorithm using liver stiffness measurement and controlled attenuation parameter can identify significant fibrosis in metabolic dysfunction-associated steatotic liver disease (MASLD) patients with indeterminate vibration-controlled transient elastography (VCTE). This optimizes diagnosis for MASLD treatment candidacy.
Area of Science:
- Hepatology
- Non-invasive Liver Disease Diagnosis
- Fibrosis Staging
Background:
- A significant portion of metabolic dysfunction-associated steatotic liver disease (MASLD) patients present with indeterminate vibration-controlled transient elastography (VCTE) results.
- Accurate fibrosis staging is crucial for identifying MASLD patients who would benefit from treatment.
Purpose of the Study:
- To develop and validate a diagnostic algorithm for identifying significant fibrosis (histological stage ≥F2) in MASLD patients with indeterminate VCTE (8-12 kPa).
- To identify candidates eligible for MASLD-specific treatments.
Main Methods:
- A real-world prospective study involving 1196 MASLD patients with paired VCTE and liver biopsy data across 6 centers.
- Development of a diagnostic algorithm using Gaussian mixture model and k-means clustering in a training cohort.
- Validation of the algorithm in internal (Spain) and external (United States) cohorts.
Main Results:
- 33-31% of MASLD patients had indeterminate VCTE across study cohorts.
- A controlled attenuation parameter cutoff of 280 dB/m differentiated fibrosis risk.
- The algorithm successfully reallocated 36% of indeterminate VCTE cases, identifying significant fibrosis in 86% of the high-risk group.
Conclusions:
- An algorithm combining liver stiffness measurement and controlled attenuation parameter thresholds effectively diagnoses significant fibrosis in MASLD patients with indeterminate VCTE.
- This approach optimizes the identification of patients for MASLD treatment, particularly those with moderate-to-advanced fibrosis.
