Simplified definition and imaging-based stratification of at-risk MASH using magnetic resonance elastography

Area of Science:

• Hepatology
• Medical Imaging
• Pharmacotherapy

Background:

• Accurate identification of at-risk metabolic dysfunction-associated steatohepatitis (MASH) is crucial for guiding therapies like resmetirom and semaglutide.
• Inconsistent definitions of at-risk MASH hinder clinical risk classification and study comparisons.
• Standardizing at-risk MASH definitions and optimizing noninvasive tools are needed for better patient stratification.

Purpose of the Study:

• To standardize the definition of at-risk MASH.
• To propose optimized magnetic resonance elastography (MRE)-based liver stiffness (LS-MRE) cutoffs.
• To improve noninvasive risk stratification and guide pharmacotherapy for MASH patients.

Main Methods:

• A prospective study involving 413 patients with suspected or diagnosed MASLD.
• Patients underwent liver biopsy and MRE at two medical centers.
• Comparison of diagnostic accuracy between LS-MRE, FIB-4, and laboratory parameters.

Main Results:

• A simplified at-risk MASH definition (fibrosis stage ≥2) identified more patients (n=122) than a stricter definition (n=77).
• LS-MRE showed high diagnostic accuracy for at-risk MASH (AUC 0.91) and cirrhosis (AUC 0.93), outperforming FIB-4 and lab tests.
• Optimized LS-MRE cutoffs (2.8-6.4 kPa) increased sensitivity (80%) for identifying pharmacotherapy candidates compared to AASLD guidelines (50%).

Conclusions:

• A simplified MASH definition broadens the identification of patients eligible for pharmacotherapy.
• LS-MRE, with optimized cutoffs, offers excellent diagnostic performance for noninvasive risk stratification.
• These findings support MRE's role in guiding eligibility for resmetirom and semaglutide, improving access to emerging MASH therapies.