Noninvasive Detection of MASH and Fibrotic Burden Using Ultrasound‐Derived LIID and LSM in MASLD: A Multicenter Study

Background and Aims Metabolic dysfunction‐associated steatohepatitis (MASH), the progressive form of metabolic dysfunction‐associated steatotic liver disease (MASLD), is associated with adverse hepatic and cardiometabolic outcomes. The study aimed to validate a novel quantitative ultrasound (QUS)‐derived score, the LIID score, for noninvasive diagnosis of MASH, and to evaluate the performance of liver stiffness measurement (LSM) using the same ultrasound platform for detecting fibrotic burden in MASLD. Methods This multicenter study enrolled 438 participants with MASLD who underwent both iLivTouch examination and liver biopsy between November 2018 and December 2024 from 10 hospitals in China. After the exclusion criteria were applied, a total of 410 patients with biopsy‐proven MASLD and successful QUS measurements were included to assess the performance of the LIID score. Results The LIID score demonstrated an area under the receiver operating characteristic curve (AUROC) of 0.71 (95% CI: 0.66–0.76) for detecting MASH. A rule‐out threshold of 6.0 achieved high sensitivity (89.6%) and negative predictive value (78.2%), whereas a rule‐in threshold of 7.8 provided high specificity (88.4%) and positive predictive value (70.5%). LSM showed excellent diagnostic performance for advanced fibrosis (AUROC: 0.86; 95% CI: 0.79–0.92) and acceptable accuracy for significant fibrosis (AUROC: 0.75; 95% CI: 0.69–0.79) and cirrhosis (AUROC: 0.78; 95% CI: 0.61–0.95). Conclusions The LIID score offers a noninvasive, ultrasound‐based approach for identifying MASH. Combined with LSM, this strategy enables comprehensive, noninvasive assessment of hepatic inflammation and fibrosis in MASLD and may reduce the need for liver biopsy in clinical practice.