TOPLINE:

A meta-analysis found that noninvasive imaging tests identified patients with “at-risk” metabolic dysfunction-associated steatohepatitis (MASH) with moderate accuracy, with a FibroScan-based scoring system performing best and other imaging-based techniques showing similar but less consistent results.

METHODOLOGY:

• At-risk MASH is associated with increased risks for liver-related events and death. Liver biopsy is invasive and subject to variability, underscoring the need for reliable noninvasive techniques for early detection.
• Investigators conducted a systematic review and meta-analysis to compare how well imaging-based tools identified patients with at-risk MASH, defined as biopsy-confirmed MASH with an activity score ≥ 4 and fibrosis stage ≥ 2 as assessed by a histopathologist.
• They searched two databases from inception through December 2024 and included eligible studies reporting data on the diagnostic accuracy of imaging-based techniques used in the diagnosis of at-risk MASH.
• The analysis compared four imaging-based approaches, namely, FibroScan-aspartate aminotransferase (FAST), magnetic resonance elastography plus fibrosis-4 (MEFIB), MRI-AST (MAST), and iron-corrected T1 (cT1) mapping, using predefined thresholds when available.
• Outcomes included sensitivity and specificity for ruling in and ruling out at-risk MASH based on pooled data from eligible participants.

TAKEAWAY:

• The meta-analysis included 20 studies with 9480 adults, with broadly similar age ranges across studies. Women made up 54.9% of MEFIB, 51.6% of MAST, 48.2% of FAST, and 41.2% of cT1 cohorts.
• For ruling out at-risk MASH, FAST (17 studies) achieved the highest sensitivity of 0.871 with a specificity of 0.567, MEFIB (three studies) had a sensitivity of 0.812 and a specificity of 0.606, and MAST (five studies) had a sensitivity of 0.716 and a specificity of 0.739.
• For ruling in at-risk MASH, FAST achieved a specificity of 0.900 and a sensitivity of 0.441, MEFIB had a specificity of 0.872 and a sensitivity of 0.500, and MAST had a specificity of 0.866 and a sensitivity of 0.502.
• cT1 mapping (three studies) showed threshold-dependent accuracy that varied widely, which prevented consistent comparisons with the other imaging-based methods.

IN PRACTICE:

“Given the findings, the FAST score may be the most practical option for wide-scale implementation, offering ease of access and a relatively lower cost compared to other diagnostic methods,” the authors wrote.

SOURCE:

The study was jointly led by Shyna Zhuoying Gunalan, Michelle Shi Ni Law, and Yi Xin Kua of the National University of Singapore in Singapore. It was published online in the American Journal of Gastroenterology.

LIMITATIONS:

Most data came from Western cohorts, with limited Asian representation. Differences in fibrosis stage distribution across studies may have affected accuracy, but the small number of studies prevented adjustment. Results showed substantial heterogeneity — especially for FAST in rule-out and for MEFIB in rule-in.

DISCLOSURES:

This study did not receive any specific funding. Several authors reported serving as consultants; receiving grants, honoraria, and payments; and having other financial and nonfinancial ties with multiple companies including Boxer Capital, Sysmex, and Roche. One author reported receiving awards and support from the Singapore Ministry of Health and other Singapore-based government organizations.

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