COMPARISONS OF DIAGNOSTIC PERFORMANCE ACCORDING TO THE SCORING SYSTEMS USING MAGNETIC RESONANCE ELASTOGRAPHY AND TRANSIENT ELASTOGRAPHY FOR DISCRIMINATING PATIENTS WITH METABOLIC-ASSOCIATED STEATOHEPATITIS AND SIGNIFICANT FIBROSIS

초록

Background: Patients with metabolic-associated steatohepatitis (MASH) with significant fibrosis (fibro-MASH) are at a higher risk of disease progression. We validated the predictive value of the MRI-aspartate aminotransferase (AST) score (MAST) and other noninvasive surrogates in predicting fibro-MASH. Methods: The retrospective analysis included 247 patients who underwent liver biopsy, MRI-based elastography (MRE) and proton density fat fraction (MRI-PDFF), transient elastography (TE), and laboratory testing for metabolic-associated steatotic liver disease (MASLD). MAST score was calculated and compared to MRE combined with fibrosis index based on four (FIB-4) index (MEFIB), MRE-based NASH score (MRE-NASH), FibroScan-AST score (FAST), non-alcoholic fatty liver disease-fibrosis score (NFS), FIB-4, and aspartate aminotransferase to platelet ratio index (APRI). Results: Fibro- MASH was pathologically diagnosed in 64 (25.9%) patients, who showed significantly higher liver stiffness (LS) value by MRE (median: 4.04 vs. 2.58 kPa) and TE (median: 14.7 vs. 7.7 kPa). LS-MRE and LS-TE excellently predicted the histologic ≥ F2, ≥ F3, and F4 (all AUCs > 0.8). MRI-PDFF showed higher AUCs (0.832–0.853) for the steatosis grade than CAP (0.673–0.704). MAST, MEFIB, and MRE-NASH showed higher AUCs (0.785, 0.794, and 0.796, respectively) than did those of FAST, NFS, APRI, and FIB-4 (0.743, 0.751, 0.675, and 0.780, respectively) for predicting Fibro-MASH, although there was no definite statistical significance. LS-MRE and LS-TE had higher AUCs for predicting Fibro-MASH (0.834 and 0.808, respectively) than the other surrogates. Conclusion: The MR-based surrogates performed acceptably in identifying fibroMASH. However, the LS value alone, measured by MRE and TE, also showed comparable predictive ability to the MR-based surrogates.