Gastroenterology · 2 h ago
Prospective study compares non-invasive tests for MASLD and MASH
A multicentre prospective study evaluated non-invasive tests against liver biopsy in 226 participants with suspected MASLD. MRI-PDFF and liver stiffness measurement showed strong diagnostic performance for steatosis and at-risk MASH, respectively, while test performance varied by threshold and disease category.
- MRI-PDFF had an AUC of 0.92 for steatosis.
- Liver stiffness measurement identified at-risk MASH with an AUC of 0.92.
- CAP performance varied substantially by cutoff.
- Discordance between MRI-PDFF and histology occurred mainly in mild disease.
Researchers conducted a multicentre prospective study in which 328 assessments from 226 participants included contemporaneous liver biopsy, MRI-PDFF, FibroScan and biochemical testing. Histopathology classified participants as having MASL, MASH or at-risk MASH; diagnostic performance was assessed using area under the receiver operating characteristic curve (AUC), sensitivity and specificity.
For histological steatosis, MRI-PDFF had an AUC of 0.92; at a 7.78% cutoff, sensitivity was 77.1% and specificity 100%. FibroScan controlled attenuation parameter (CAP) at 248 dB/m was sensitive (94.7%) but had low specificity (30.4%); at 304 dB/m, specificity was 91.3% and sensitivity 60.3%. A CAP–ALT algorithm had 78.3% sensitivity and 82.6% specificity. FAST identified MASH with an AUC of 0.85, while liver stiffness measurement detected at-risk MASH with an AUC of 0.92, sensitivity of 86.5% and specificity of 84.1%.
The findings support further evaluation of stepwise non-invasive assessment, but do not establish a preferred pathway. Results come from a prospective real-world cohort, and MRI-PDFF discordance with histology occurred mainly in mild disease.
In practice
For clinicians assessing people with MASLD, the study provides comparative diagnostic estimates for MRI-PDFF, CAP, FAST and liver stiffness measurement against biopsy. MRI-PDFF performed well for steatosis, and liver stiffness measurement for at-risk MASH; CAP results depended on the selected cutoff. These findings may inform consideration of non-invasive assessment strategies, but the study does not establish a preferred pathway or show that using these tests improves patient outcomes. The cohort included 226 participants, and discordance was noted in mild disease.
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Diabetes, Obesity and Metabolism: Assessment of Non‐Invasive Tests for MASLD , MASH and At‐Risk MASH in a Multicentre Prospective Real‐World Study ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.