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Head-to-head comparison among FAST, MAST, and multiparametric MRI-based new score in diagnosing at-risk MASH
Kento Imajo1,2,3, Yusuke Saigusa4, Takashi Kobayashi1
1Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
Objectives:
New scores were developed to identify at-risk metabolic dysfunction-associated steatohepatitis (MASH) using multiparametric MRI (mpMRI).
Materials And Methods:
A prospective study was conducted on 176 patients with suspected or diagnosed metabolic dysfunction-associated steatotic liver disease (MASLD) paired with an MR scan, vibration-controlled transient elastography (VCTE), and liver biopsy. Liver stiffness measurement (LSM) using magnetic resonance elastography (MRE), proton density fat fraction (PDFF), and mpMRI-based corrected T1 (cT1) were combined to develop a one-step strategy, named MPcT (MRE + PDFF + cT1, combined score), and a two-step strategy-MRE-based LSM followed by PDFF with cT1 (M-PcT, paired score) for diagnosing at-risk MASH. Each model was categorized using rule-in and rule-out criteria (three categorized analyses). To avoid overfitting, the diagnostic accuracies were evaluated based on 5-fold cross-validation.
Results:
PDFF + cT1 (PcT) had the highest diagnostic performance for severe activity (hepatic inflammation plus ballooning grade ≥ 3) and for NAS ≥ 4 (active MASH). Areas under receiver operating characteristic curves (AUROCs) of M-PcT (0.832) for detecting at-risk MASH were significantly higher than those of Fibroscan-AST (FAST) (0.744, p = 0.017), MRI-AST (MAST) (0.710, p = 0.002), and MPcT (0.695, p < 0.001) in three categorized analysis. Following the rule-in criteria, positive predictive values of M-PcT (84.5%) were higher than those of FAST (73.5%), MAST (70.0%), and MPcT (66.7%). Following the rule-out criteria, negative predictive values of M-PcT (88.7%) were higher than those of FAST (84.0%), MAST (73.9%), and MPcT (84.9%).
Conclusions:
The two-step strategy, M-PcT (paired score), showed the reliability of rule-in/-out for at-risk MASH, with better predictive performance compared with FAST and MAST (combined score).
Clinical Trial Registration:
This study is registered with ClinicalTrials.gov (number, UMIN000012757).
Key Points:
Question There is no mpMRI-based method for detecting as-risk MASH (NAFLD activity score ≥ 4 with fibrosis stage ≥ 2) like FAST and MAST scores. Findings MRE-based LSMs followed by PDFF with cT1 (M-PcT) were more useful in detecting at-risk MASH than the combined score (FAST and MAST). Clinical relevance By combining MRE and PDFF with cT1, it becomes possible to evaluate the pathology of MASH without the need for a liver biopsy, assisting in prognosis prediction and decision-making for treatment options.
Insights
New multiparametric MRI (mpMRI) scores can identify patients at risk for metabolic dysfunction-associated steatohepatitis (MASH). The M-PcT strategy, combining MRE, PDFF, and cT1, offers reliable rule-in/-out criteria for at-risk MASH.
Area of Science:
- Radiology and Medical Imaging
- Hepatology
- Biomarkers
Background:
- Metabolic dysfunction-associated steatohepatitis (MASH) requires accurate non-invasive diagnostic methods.
- Current multiparametric MRI (mpMRI) based scores for MASH risk stratification have limitations.
Purpose of the Study:
- To develop and validate novel mpMRI-based scoring strategies for identifying at-risk MASH.
- To compare the diagnostic performance of new strategies against existing scores like FAST and MAST.
Main Methods:
- A prospective study involved 176 patients with suspected metabolic dysfunction-associated steatotic liver disease (MASLD).
- Magnetic resonance elastography (MRE) for liver stiffness measurement (LSM), proton density fat fraction (PDFF), and mpMRI-based corrected T1 (cT1) were utilized.
- Two strategies were developed: MPcT (one-step combined score) and M-PcT (two-step sequential score).
- Diagnostic accuracy was assessed using 5-fold cross-validation with rule-in and rule-out criteria.
Main Results:
- The M-PcT strategy demonstrated superior diagnostic performance for at-risk MASH compared to FAST and MAST.
- M-PcT achieved higher Areas Under the Receiver Operating Characteristic Curves (AUROCs) (0.832) than FAST (0.744) and MAST (0.710).
- M-PcT showed improved positive (84.5%) and negative (88.7%) predictive values for MASH risk stratification.
Conclusions:
- The M-PcT two-step strategy reliably identifies patients at risk for MASH using non-invasive mpMRI techniques.
- This approach offers improved predictive performance over existing scores, potentially reducing the need for liver biopsy.
- M-PcT aids in prognosis prediction and treatment decision-making for MASH patients.
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