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Related Experiment Video

Updated: May 11, 2026

Predicting Treatment Response to Image-Guided Therapies Using Machine Learning: An Example for Trans-Arterial Treatment of Hepatocellular Carcinoma
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HCC Is the Predominant Liver-Related Event in MASLD: 2-Step Non-Invasive Algorithms to Stratify Risk in Non-Cirrhotic

Madalina-Gabriela Indre1,2,3, Bernardo Stefanini1,2, Maria Boe1,2

  • 1Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.

Journal of Hepatocellular Carcinoma
|March 23, 2026
PubMed
Summary

Hepatocellular carcinoma (HCC) can develop in metabolic dysfunction-associated steatotic liver disease (MASLD) without cirrhosis. Liver stiffness measurement (LSM-SSI) effectively identifies patients at low risk, enhancing surveillance strategies.

Keywords:
2D-SWEMASLDhepatocellular carcinomaliver imagingultrasound elastography

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Area of Science:

  • Hepatology
  • Oncology
  • Non-invasive diagnostics

Background:

  • Metabolic dysfunction-associated steatotic liver disease (MASLD) is increasingly linked to hepatocellular carcinoma (HCC), even in non-cirrhotic patients.
  • The risk stratification and surveillance necessity for HCC in non-cirrhotic MASLD patients remain unclear.
  • Identifying high-risk individuals for HCC surveillance is crucial for early detection and improved outcomes.

Purpose of the Study:

  • To assess the risk of HCC in non-cirrhotic MASLD patients.
  • To evaluate the utility of liver stiffness measurement using SuperSonic Imagine (LSM-SSI) for HCC risk stratification.
  • To develop an algorithm for precise HCC surveillance in MASLD.

Main Methods:

  • A prospective MASLD cohort analysis involving 352 patients with median follow-up of 31 months.
  • Liver stiffness measurement (LSM-SSI) was performed at baseline, with surveillance every 6-12 months.
  • Optimized LSM-SSI cut-offs (<7.4 kPa, ≥15.6 kPa) and a two-step algorithm (LSM-SSI + PLEASE score) were used for risk stratification.

Main Results:

  • Among 352 patients, 9 (2.6%) developed HCC. No HCC events occurred in patients with LSM-SSI <7.4 kPa.
  • LSM-SSI was significantly associated with HCC risk in non-cirrhotic patients (HR 1.542, p<0.0001).
  • Independent HCC predictors included LSM-SSI, type 2 diabetes mellitus, and gamma-glutamyl transferase. The two-step algorithm achieved 100% negative predictive value and 89.5% accuracy.

Conclusions:

  • Hepatocellular carcinoma (HCC) is a significant risk in non-cirrhotic MASLD patients.
  • LSM-SSI <7.4 kPa effectively rules out high-risk individuals for HCC.
  • A two-step algorithm combining LSM-SSI and PLEASE score enhances HCC surveillance precision in MASLD.