Combination of quantitative MRI and laboratory markers for the detection and staging of metabolic dysfunction-associated steatotic liver disease

Abstract Objectives Metabolic dysfunction-associated steatotic liver disease (MASLD) is increasing both in numbers and severity worldwide. Non-invasive alternatives to liver biopsy, particularly for the detection of metabolic dysfunction-associated steatohepatitis (MASH), have proven difficult to establish. We aimed to assess whether quantitative MRI (qMRI) alone and in combination with laboratory and anthropometric measurements and other non-invasive tests (NITs) can detect stages of MASLD. Materials and methods In this single-center prospective cohort study, 91 participants with hepatic steatosis on ultrasound or vibration-controlled transient elastography were enrolled in the outpatient clinics between September 2018 and January 2024. Patients underwent blood sampling, qMRI and liver biopsy. Non-invasive parameters were correlated with histopathology in all 91 participants, of whom 37 were reported previously. Prediction models for advanced steatosis (S3), MASH, fibro-MASH (S ≥ 1, lobular inflammation ≥ 1, hepatocyte ballooning ≥ 1 and F ≥ 2), significant (≥ F2) and advanced (≥ F3) fibrosis were designed based on 88 MASLD patients. Results MR elastography (MRE)-derived elasticity (MRE-G’), MRE-derived stiffness (MRE-Gabs) and LiverMultiScan® iron-corrected T1 (cT1) correlated with hepatocyte ballooning (Spearman’s R: 0.45 ( p < 0.001); 0.42 ( p < 0.001); 0.38 ( p < 0.001)). Prediction models for ≥ F3 outperformed MAF5 and FIB4, but did not outperform ELF or NFS. A model combining cT1, MRE-G’, aspartate aminotransferase and alanine aminotransferase yielded an AUC of 0.83 (95% CI: 0.74–0.93) for fibro-MASH, not outperforming FibroScan-AST-score (FAST) or cT1-AST-fasting glucose score (cTAG) ( p = 0.130; p = 0.284). Conclusion qMRI parameters are able to differentiate degrees of MASLD severity. Generally, the addition of other available measurements did not significantly improve accuracy compared to individual qMRI parameters or established NITs. Key Points Question Refinement of non-invasive tools is needed to accurately stage metabolic-associated steatotic liver disease (MASLD), particularly progressive disease and significant and advanced fibrosis. Findings Quantitative MRI has good diagnostic accuracy to stage MASLD. The combination of MRI parameters with laboratory and anthropometric measurements has limited additional benefit. Clinical relevance This research provides valuable insights for clinicians seeking to reduce reliance on liver biopsy. The findings could be applied in clinical settings to guide earlier, less invasive diagnosis and disease monitoring, allowing for timely interventions and more personalized treatment strategies. Graphical Abstract