Morphometric Quantification of Steatosis and Fibrosis in Metabolic Liver Disease Associated With Type 2 Diabetes

Liver biopsy remains the reference standard for diagnosing steatohepatitis in metabolic dysfunction-associated steatotic liver disease (MASLD), but its use is limited by interobserver variability. Morphometric analysis offers continuous and objective quantification of steatosis and fibrosis, potentially overcoming these limitations.

We compared morphometric quantification of steatosis and fibrosis to noninvasive imaging in 233 patients with type 2 diabetes mellitus (T2DM) enrolled in the QUID-NASH project. Steatosis was assessed by magnetic resonance imaging-proton density fat fraction (MRI-PDFF), and liver stiffness by magnetic resonance elastography (MRE) and vibration-controlled transient elastography (VCTE). Morphometry was performed on biopsy slides measuring steatosis proportionate area (SPA) and collagen proportionate area (CPA).

Steatosis grade was related to SPA (P < .0001), which was significantly correlated with %PDFF (rho: 0.88; 95% confidence interval [CI], 0.82-0.91). Median SPA increased from 0.85% in Grade 0 to 19.85% in Grade 3; MRI-PDFF values ranged from 4.25% to 33.67%. Fibrosis stage was related to CPA and weakly correlated with liver stiffness measurement (LSM) by MRE (rho: 0.26; 95% CI, 0.12-0.39), and moderately with LSM by VCTE (rho: 0.52; 95% CI, 0.42-0.61). Fibrosis stage was significantly associated with CPA (P < .0001), which increased from 3.17% in stage 0 to 18.05% in stage 4.

Our study demonstrates the relevance of quantitative morphometric assessment of steatosis and fibrosis in patients with T2DM and MASLD. Such an easily applicable approach could be used in routine practice to better characterize 2 cardinal features of the disease and to improve monitoring.