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A combination of non-invasive tests for the detection of significant fibrosis in patients with metabolic dysfunction-associated steatotic liver disease is not superior to magnetic resonance elastography alone

  • Gastrointestinal
  • Published:
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Abstract

Objectives

The aims of the present study were to investigate a combination of magnetic resonance elastography (MRE) and vibration-controlled transient elastography (VCTE) or MRE and fibrosis score 4 (FIB-4) in the detection of significant fibrosis in patients with metabolic dysfunction-associated steatotic liver disease (MASLD).

Methods

Between November 5, 2021, and March 4, 2022, a total of 119 consecutive patients with MASLD were included. Liver stiffness was measured using liver biopsy, MRE, VCTE, and FIB-4. Data were collected from outpatient visit charts. Significant fibrosis was defined as ≥ stage 2 fibrosis.

Results

All 119 MASLD patients were Caucasian, and their median age was 55 years. MRE, VCTE, and FIB-4 demonstrated significant accuracy in the detection of significant fibrosis with an area under the ROC curve (AUC) of 0.848 ± 0.036 (p < 0.001), 0.632 ± 0.052 (p = 0.012), and 0.664 ± 0.051 (p = 0.001), respectively. However, the diagnostic performance of MRE was superior compared to that of VCTE (AUC difference: 0.216 ± 0.053, p < 0.001) and FIB-4 (AUC difference: 0.184 ± 0.058, p = 0.001). With logistic regression analysis, it was determined that when compared to MRE alone, a combination of MRE and TE (p = 0.880) or MRE and FIB-4 (p = 0.455) were not superior for detecting significant fibrosis.

Conclusions

MRE alone is an accurate and non-invasive method for the identification of MASLD patients with significant fibrosis.

Clinical relevance statement

Magnetic resonance elastography alone accurately detects significant fibrosis in patients with metabolic dysfunction-associated steatotic liver disease.

Key Points

• In routine clinical practice, several non-invasive biochemical-based biomarkers and imaging methods are widely used to assess liver fibrosis in patients with metabolic dysfunction-associated steatotic liver disease.

• Magnetic resonance elastography (MRE) is more accurate than vibration-controlled transient elastography (VCTE) or fibrosis score 4 (FIB-4) for assessing liver fibrosis and identifying significant fibrosis in patients with metabolic dysfunction-associated steatotic liver disease.

• The combination of MRE and VCTE or MRE and FIB-4 was not superior to MRE alone.

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Abbreviations

ALT:

Alanine aminotransferase

AST:

Aspartate aminotransferase

AUC:

Area under the ROC curve

CAP:

Controlled attenuation parameter

CI:

Confidence interval

CRN:

NASH-Clinical Research Network

FIB-4:

Fibrosis score 4

GGT:

Gamma-glutamyl transpeptidase

IQR/M:

Interquartile range/median value

IQR:

Interquartile range

kPa:

Kilopascal

LDL:

Low-density lipoprotein

MAS:

Metabolic dysfunction-associated steatosis

MASH:

Metabolic dysfunction-associated steatohepatitis

MASLD:

Metabolic dysfunction-associated steatotic liver disease

MRE:

Magnetic resonance elastography

MR-PDFF:

MR-proton density fat fraction

NAFL:

Nonalcoholic fatty liver

NAFLD:

Non-alcoholic fatty liver disease

NASH:

Nonalcoholic steatohepatitis

OR:

Odds ratio

PPV:

Positive predictive value

SLD:

Steatotic liver disease

VCTE:

Vibration-controlled transient elastography

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Acknowledgements

The authors would like to thank all the radiology team, gastroenterology staff, and pathologists at Ankara University School of Medicine, Ankara, Turkey.

Funding

The authors state that this work has not received any funding.

Author information

Authors and Affiliations

  1. Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey

    Serkan Duman, Mesut Gumussoy, Hale Gokcan, Bahar Ulas, Zeynep Ellik, Mubin Ozercan, Ramazan Erdem Er, Fatih Karakaya, Emin Bodakci & Ramazan Idilman

  2. Department of Radiology, Ankara University School of Medicine, Ankara, Turkey

    Digdem Kuru & Ayse Erden

  3. Department of Pathology, Ankara University School of Medicine, Ankara, Turkey

    Saba Kiremitci & Berna Savas

  4. Department of Biostatistics, Ankara University School of Medicine, Ankara, Turkey

    Atilla H. Elhan

  5. NAFLD Research Center, Division of Gastroenterology, University of California at San Diego, La Jolla, CA, USA

    Rohit Loomba

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  1. Serkan Duman
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Corresponding authors

Correspondence to Serkan Duman or Ramazan Idilman.

Ethics declarations

Guarantor

The scientific guarantor of this publication is Ramazan Idilman.

Conflict of interest

For all authors, except Rohit Loomba, there are none to declare conflicts of interest, no financial support was received for the conduct of this study. Rohit Loomba serves as a consultant to Aardvark Therapeutics, Altimmune, Anylam/Regeneron, Amgen, Arrowhead Pharmaceuticals, AstraZeneca, Bristol-Myer Squibb, CohBar, Eli Lilly, Galmed, Gilead, Glympse bio, Hightide, Inipharma, Intercept, Inventiva, Ionis, Janssen Inc., Madrigal, Metacrine, Inc., NGM Biopharmaceuticals, Novartis, Novo Nordisk, Merck, Pfizer, Sagimet, Theratechnologies, 89 bios, Terns Pharmaceuticals and Viking Therapeutics. In addition, his institutions received research grants from Arrowhead Pharmaceuticals, AstraZeneca, Boehringer-Ingelheim, Bristol-Myers Squibb, Eli Lilly, Galectin Therapeutics, Galmed Pharmaceuticals, Gilead, Intercept, Hanmi, Intercept, Inventiva, Ionis, Janssen, Madrigal Pharmaceuticals, Merck, NGM Biopharmaceuticals, Novo Nordisk, Merck, Pfizer, Sonic Incytes and Terns Pharmaceuticals. Co-founder of LipoNexus Inc.

Ramazan Idilman is a member of the Science Academy.

Statistics and biometry

One of the authors (Atilla H Elhan) has significant statistical expertise.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

This study was approved by the ethics committee of the Ankara University School of Medicine.

Study subjects or cohorts overlap

None of these study subjects were previously reported.

Methodology

• Retrospective

• Diagnostic or prognostic study

• Performed at one institution

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Duman, S., Kuru, D., Gumussoy, M. et al. A combination of non-invasive tests for the detection of significant fibrosis in patients with metabolic dysfunction-associated steatotic liver disease is not superior to magnetic resonance elastography alone. Eur Radiol (2023). https://doi.org/10.1007/s00330-023-10441-5

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