Point shear wave elastography for non-invasive detection of advanced fibrosis in metabolic dysfunction-associated steatotic liver disease: a prospective histologically validated study

Background Metabolic dysfunction–associated steatotic liver disease (MASLD) is the most common chronic liver disease worldwide, and fibrosis stage is the strongest predictor of liver-related outcomes. Point shear wave elastography (pSWE), based on acoustic radiation force impulse technology, is widely available in routine ultrasound systems; however, histologically validated data in well-characterized MASLD cohorts remain limited. This study aimed to evaluate the diagnostic performance of pSWE for the detection of advanced fibrosis (≥ F3) using histology as the reference standard. Methods In this prospective single-center study, adult patients with MASLD undergoing clinically indicated liver biopsy were included. Liver stiffness was assessed using pSWE on a Siemens ultrasound system. Histological fibrosis staging (F0–F4) was performed by three blinded liver pathologists. Diagnostic performance for advanced fibrosis (≥ F3) was evaluated using receiver operating characteristic (ROC) analysis. Clinically applicable rule-in and rule-out thresholds were determined using predefined sensitivity- and specificity-based criteria. Results A total of 59 patients with MASLD and numerically evaluable pSWE measurements were included. Advanced fibrosis (≥ F3) was present in 18/59 patients (30.5%). pSWE demonstrated excellent diagnostic performance for the detection of advanced fibrosis, with an AUROC of 0.90 (95% CI 0.82–0.97). A threshold of 1.255 m/s achieved 100% sensitivity and 100% negative predictive value, supporting a rule-out strategy. A threshold of 1.96 m/s achieved 97.6% specificity and 91.7% positive predictive value, supporting a rule-in strategy. Shear wave velocity correlated significantly with histological fibrosis stage (Spearman ρ = 0.68, p < 0.001). Conclusion Point shear wave elastography provides reliable non-invasive detection of advanced fibrosis in MASLD. Technique-specific thresholds enable clinically meaningful rule-in and rule-out strategies and may support integration of pSWE into stepwise non-invasive fibrosis risk stratification pathways.