Two-Step MRI and Clinical Model for Detecting At-Risk Steatohepatitis in Metabolic Liver Disease

Area of Science:

• Hepatology
• Diagnostic Imaging
• Non-invasive Biomarkers

Background:

• Accurate identification of at-risk metabolic dysfunction-associated steatohepatitis (MASH) with significant fibrosis (≥ stage 2) is clinically essential.
• Existing non-invasive markers like the steatosis-associated fibrosis estimator (SAFE) score for fibrosis and MR-MASH score for MASH have shown promise individually.
• The combined diagnostic performance of these non-invasive tests for identifying at-risk MASH requires further investigation.

Purpose of the Study:

• To evaluate the diagnostic accuracy of serial combinations of non-invasive tests for identifying at-risk MASH (≥ stage 2 fibrosis).
• To compare the performance of different two-step non-invasive testing strategies in both clinical and population-based cohorts.
• To determine the optimal non-invasive strategy for predicting MASH with significant fibrosis.

Main Methods:

• A two-part study was conducted involving patients with metabolic dysfunction-associated steatotic liver disease (MASLD).
• Part 1 analyzed 286 MASLD patients from an Asian center with biopsy-proven diagnoses, comparing four two-step strategies.
• Part 2 validated selected strategies in 495 MASLD patients from the UK Biobank using corrected T1 values.

Main Results:

• The serial combination of SAFE score followed by MR-MASH score (strategy A) demonstrated superior accuracy (87.8%) in identifying at-risk MASH compared to other strategies in Part 1.
• Strategy A showed higher accuracy (88.5%) and lower misclassification rates (9.1%) compared to Fibrosis-4 followed by a magnetic resonance-based model (strategy B).
• In Part 2, strategy A maintained a high negative predictive value (99.7%) and exhibited lower misclassification (3.6%) than strategy B, with comparable accuracy.

Conclusions:

• The serial combination of the SAFE score and the MR-MASH score is an effective strategy for predicting at-risk MASH.
• This non-invasive approach offers a reliable method for identifying patients with MASH and significant fibrosis.
• The findings support the clinical utility of combining SAFE and MR-MASH for MASH diagnosis.