TOPLINE

A novel quantitative ultrasound-derived liver inflammation and injury detection (LIID) score identified metabolic dysfunction-associated steatohepatitis (MASH) with acceptable accuracy in patients with biopsy-proven metabolic dysfunction-associated steatotic liver disease (MASLD). Liver stiffness measurement (LSM) using the same ultrasound platform showed excellent performance for identifying advanced fibrosis.

METHODOLOGY

• As MASH often progresses asymptomatically and reliable noninvasive diagnostic markers remain limited, liver biopsy remains the reference standard for diagnosis and staging despite its well-recognized limitations. The quantitative ultrasound-derived LIID score previously showed promise for noninvasive MASH detection in a single-center study but had not been validated in a multicenter cohort.
• Researchers conducted a multicenter study involving 410 patients (mean age, 44.7 years; 46.6% men) with biopsy-proven MASLD from 10 hospitals in China to validate the diagnostic performance of the LIID score for identifying MASH and to assess the accuracy of LSM on the same ultrasound platform for detecting fibrotic burden.
• Patients underwent an iLivTouch examination, during which LSM and ultrasound attenuation parameters were measured; the LIID score was derived from quantitative ultrasound data, incorporating intensity, frequency, scattering, and attenuation characteristics of the ultrasound signals.
• Liver biopsy was performed under ultrasound guidance, and specimens were reviewed independently by 2 pathologists. MASH was defined by the presence of hepatic steatosis, lobular inflammation, and ballooning with nonalcoholic fatty liver disease activity score ≥ 5. Significant fibrosis was defined as fibrosis stage ≥ 2 (F ≥ 2), advanced fibrosis as F3 or F4, and cirrhosis as F4.

TAKEAWAY

• The LIID score showed acceptable diagnostic accuracy for detecting MASH, achieving an area under the receiver operating characteristic curve (AUROC) of 0.71 (95% CI, 0.66-0.76). At the lower cutoff of 6.0, it identified 89.6% of patients who had MASH, making it useful for ruling the condition out. Raising the cutoff to 7.8 meant 70.5% of flagged patients truly had MASH, but sensitivity fell to 26.1%.
• Each 1-unit increase in the LIID score was associated with higher odds of MASH, and the association persisted after adjustment for LSM (odds ratio, 1.93; 95% CI, 1.57-2.38).
• LSM demonstrated high diagnostic accuracy for detecting advanced fibrosis (AUROC, 0.86; 95% CI, 0.79-0.92) while showing acceptable accuracy for detecting significant fibrosis (AUROC, 0.75; 95% CI, 0.69-0.79) and cirrhosis (AUROC, 0.78; 95% CI, 0.61-0.95).
• When LSM readings fell below the optimal cutoffs — 9.8, 11.6, and 15.6 kPa — negative predictive values were 78.8% for significant fibrosis, 97.4% for advanced fibrosis, and 98.8% for cirrhosis. A low reading can therefore help rule out advanced fibrosis and cirrhosis, sparing some patients a biopsy.

IN PRACTICE

"The combination of LIID and LSM in a single ultrasound device provides a noninvasive, efficient solution for diagnosing MASH and staging liver fibrosis in MASLD patients. This integration can streamline diagnostic workflows and reduce the need for liver biopsy, offering a cost-effective and accessible option for patient management," the authors wrote.

SOURCE

The study was led by Feng Gao, The First Affiliated Hospital of Wenzhou Medical University, in Wenzhou, China. It was published online in Journal of Gastroenterology and Hepatology.

LIMITATIONS

The LIID score showed modest diagnostic performance and requires further optimization. The study enrolled patients exclusively from Chinese tertiary centers, which may have limited generalizability to other ethnic or community-based populations.

DISCLOSURES

This study was supported by grants from the National Natural Science Foundation of China. The authors declared having no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.