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

• Published in: European radiology Vol. 34; no. 6; pp. 3882 - 3888
• Main Authors: Duman, Serkan, Kuru, Digdem, Gumussoy, Mesut, Kiremitci, Saba, Gokcan, Hale, Ulas, Bahar, Ellik, Zeynep, Ozercan, Mubin, Er, Ramazan Erdem, Karakaya, Fatih, Bodakci, Emin, Erden, Ayse, Elhan, Atilla H., Savas, Berna, Loomba, Rohit, Idilman, Ramazan
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-06-2024; Springer Nature B.V
• Subjects: Adult; Aged; Biomarkers; Biopsy; Diagnostic Radiology; Elasticity Imaging Techniques - methods; Fatty Liver - complications; Fatty Liver - diagnostic imaging; Female; Fibrosis; Gastrointestinal; Humans; Imaging; Internal Medicine; Interventional Radiology; Liver; Liver - diagnostic imaging; Liver - pathology; Liver cirrhosis; Liver Cirrhosis - complications; Liver Cirrhosis - diagnostic imaging; Liver diseases; Magnetic resonance; Magnetic Resonance Imaging - methods; Male; Medicine; Medicine & Public Health; Metabolism; Middle Aged; Neuroradiology; Radiology; Regression analysis; ROC Curve; Ultrasound; Vibration; Metabolic dysfunction-associated steatohepatitis; Magnetic resonance elastography; Nonalcoholic fatty liver disease; Metabolic dysfunction-associated steatotic liver disease; Non-invasive
• ISSN: 1432-1084; 0938-7994; 1432-1084
• DOI: 10.1007/s00330-023-10441-5

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.