The Relationship Between Non-Invasive Tests and Digital Pathology for Quantifying Liver Fibrosis in MASLD.

Area of Science:

• Hepatology
• Medical Imaging
• Digital Pathology

Background:

• Evaluating liver fibrosis is critical in metabolic dysfunction-associated steatotic liver disease (MASLD).
• Digital pathology offers automated, quantitative fibrosis measurement, improving accuracy and reducing variability.
• The relationship between digital pathology and non-invasive tests (NITs) for fibrosis assessment in MASLD is not well understood.

Purpose of the Study:

• To explore the correlation between digital pathology quantitative fibrosis parameters and various non-invasive tests (NITs) in MASLD patients.
• To evaluate the diagnostic performance of digital pathology and NITs in assessing liver fibrosis stages.

Main Methods:

• A study involving 99 biopsy-proven MASLD patients.
• Quantitative fibrosis (Q-Fibrosis) was measured using second-harmonic generation/two-photon excitation fluorescence microscopy (SHG/TPEF).
• Correlations between eight NITs and quantified fibrosis parameters (q-FPs) were analyzed.

Main Results:

• Q-Fibrosis showed excellent diagnostic performance for fibrosis staging (AUCs 0.924-0.967).
• Magnetic resonance elastography (MRE) demonstrated the highest diagnostic accuracy among NITs (AUC 0.781-0.977).
• MRE-liver stiffness measurement (MRE-LSM) exhibited the strongest correlation with q-FPs, influenced by collagen characteristics.

Conclusions:

• Both MRE and digital pathology are highly accurate for diagnosing liver fibrosis in MASLD.
• MRE-LSM is significantly influenced by the extent, location, and pattern of collagen deposition.
• This provides novel insights into MRE changes related to histological fibrosis reversal.