A prospective study international study involving 114 adults found that combining two ultrasound methods accurately assessed metabolic dysfunction-associated steatohepatitis and liver fibrosis, offering a noninvasive alternative to biopsy.
Participants were enrolled from four tertiary hospitals in China and South Korea between August 2021 and December 2023. All underwent liver biopsy due to suspected metabolic dysfunction–associated steatohepatitis (MASH), abnormal liver function, or evaluation for living liver donation. Quantitative ultrasound (US) tests were performed before biopsy using a standardized imaging system and protocol.
Researchers evaluated three US parameters: tissue attenuation imaging (TAI), tissue scatter-distribution imaging (TSI), and two-dimensional shear-wave elastography (SWE). TAI and TSI measured liver fat content, while SWE measured liver stiffness as an indicator of fibrosis.
Among the 114 participants (median age, 40 years; 67 women), 76 (66.7%) were diagnosed with MASH and 39 (34.2%) with high-risk MASH, defined as fibrosis stage F2 or higher.
TSI demonstrated strong diagnostic performance for detecting liver steatosis. For steatosis grade S1 or higher, TSI demonstrated an AUC of 0.94 (95% confidence interval [CI]: 0.90, 0.98), with 89% sensitivity (90 of 101) and 100% specificity (13 of 13). For inflammation grade I1 or higher, TSI showed an AUC of 0.84 (95% CI: 0.75, 0.92), with 79% sensitivity (68 of 86) and 79% specificity (22 of 28).
SWE showed high diagnostic accuracy for liver fibrosis. For fibrosis stage F2 or higher, SWE had an AUC of 0.96 (95% CI: 0.92, 1.00), with 90% sensitivity (28 of 42) and 93% specificity (67 of 72). For cirrhosis (stage F4), SWE achieved an AUC of 0.97 (95% CI: 0.94, 1.00), with 100% sensitivity (3 of 3) and 96% specificity (107 of 111).
Researchers developed a model combining TSI and SWE to improve the detection of MASH and high-risk MASH. For MASH, the combined model had an AUC of 0.92 (95% CI: 0.85, 0.98), with 80% sensitivity (61 of 76) and 95% specificity (36 of 38). For high-risk MASH, the combined model showed an AUC of 0.82 (95% CI: 0.74, 0.90), with 79% sensitivity (31 of 39) and 81% specificity (61 of 75).
All diagnoses were confirmed by histopathologic analysis of liver biopsy specimens. Liver biopsy is the reference standard for diagnosing and staging hepatic steatosis and fibrosis, but it is invasive and costly.
The study found that TAI, TSI, and SWE were effective in detecting hepatic steatosis, inflammation, and fibrosis. The combination of TSI and SWE yielded an AUC of 0.92 for MASH and 0.82 for high-risk MASH.
The study concludes that combining TAI, TSI, and SWE may support noninvasive diagnosis of MASH and high-risk MASH, though further validation is needed.
Full disclosures can be found in the published study.
Source: Radiology