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Updated: Sep 11, 2025
Measurement of Liver Stiffness Using Atomic Force Microscopy Coupled with Polarization Microscopy
Published on: July 20, 2022
Use of liver stiffness measurement for HCC risk stratification in metabolic dysfunction-associated steatotic liver
Binu V John1,2, Dustin R Bastaich1,3, Yangyang Deng1,4
1Division of Gastroenterology and Hepatology, Department of Medicine, Miami VA Medical System, Miami, Florida, USA.
Insights
Liver stiffness measurement (LSM) predicts hepatocellular carcinoma (HCC) risk in metabolic dysfunction-associated steatotic liver disease (MASLD). Consider HCC surveillance for non-cirrhotic MASLD patients with diabetes and LSM ≥10 kPa.
Area of Science:
- Hepatology
- Oncology
- Radiology
Background:
- Metabolic dysfunction-associated steatotic liver disease (MASLD) is a rapidly growing cause of hepatocellular carcinoma (HCC).
- A significant portion of MASLD-HCC cases occur without cirrhosis, highlighting a need for predictive tools.
- Current methods for predicting HCC risk in MASLD are insufficient.
Purpose of the Study:
- To investigate the association between liver stiffness measurement (LSM) and HCC risk in patients with MASLD.
- To determine if specific LSM thresholds can predict HCC development.
- To identify patients with MASLD who would benefit from cost-effective HCC surveillance.
Main Methods:
- Retrospective analysis of the Veterans Analysis of Liver Disease (VALID) cohort.
- Inclusion of patients with MASLD who underwent transient elastography.
- Utilized multivariable Cox proportional models to assess the relationship between LSM and HCC risk.
Main Results:
- Increased LSM was significantly associated with higher HCC risk in MASLD patients.
- HCC risk rose by 18% for every 5 kPa increase in LSM.
- Annual HCC incidence per 100 person-years increased with higher LSM values, particularly in patients with diabetes and LSM ≥10 kPa.
Conclusions:
- Liver stiffness measurement (LSM) is a valuable predictor of HCC risk in MASLD.
- HCC surveillance is recommended for non-cirrhotic MASLD patients who have diabetes and an LSM of ≥10 kPa.
- These findings aid in optimizing HCC surveillance strategies for high-risk MASLD populations.
Background And Aims:
Metabolic dysfunction-associated steatotic liver disease (MASLD) is the fastest-rising cause of HCC. A third of MASLD-HCC occur in the absence of cirrhosis, but tools to predict MASLD-HCC are lacking. Our study aimed to examine whether liver stiffness measurement (LSM) is associated with HCC risk in MASLD, identify if LSM thresholds can predict HCC risk, and identify patients for cost-effective HCC surveillance.
Approach And Results:
We conducted a retrospective study of the Veterans Analysis of Liver Disease (VALID) cohort and included patients with MASLD who underwent transient elastography between May 27, 2014, and June 1, 2023. HCC incidence rates were calculated, and we fit multivariable Cox proportional models to study the association of LSM with HCC risk. Among 30,414 participants with MASLD followed over 69,974 person-years (PY), HCC risk increased by 18% with every 5 kPa increase in LSM (subdistribution hazard ratio: 1.18, 95% CI: 1.14-1.21). The annual incidence of HCC per 100 PY was 0.34 (0.24-0.49) with LSM 10-14.9, 0.45 (0.27-0.76) with LSM 15-19.9, 0.78 (0.50-1.20) for LSM 20-24.9, and 0.94 (0.68-1.29) per 100 PY with LSM ≥25 kPa. In patients with MASLD without cirrhosis or clinically significant portal hypertension, diabetes, and an LSM of ≥10 kPa, annual HCC rates were 0.46 per 100 PY (0.29-0.78), which is above the previously described threshold for cost-effectiveness for HCC surveillance.
Conclusions:
LSM is associated with HCC risk in MASLD. HCC surveillance should be considered in noncirrhotic MASLD with diabetes and LSM of ≥10 kPa.
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