Multiparametric ultrasound for non-invasive assessment of liver steatosis, fibrosis, and inflammation in metabolic dysfunction-associated steatotic liver disease.

Background: In metabolic dysfunction-associated steatotic liver disease (MASLD) the identification of patients at high risk of evolution to metabolic dysfunction-associated steatohepatitis (MASH) is challenging.

Aim: To investigate the performance of different ultrasound (US)-based techniques for the non-invasive assessment of liver fibrosis, steatosis, and inflammation in these patients.

Methods: We collected data from consecutive patients who underwent liver biopsy for suspected MASLD between January 2019 and December 2021. Two-dimensional shear-wave elastography, sound speed plane-wave US, attenuation plane-wave US, viscosity plane-wave US (Vi.PLUS) using Aixplorer MACH 30 system, and transient elastography and controlled attenuation parameter from FibroScan were measured before biopsy.

Results: A total of 120 participants were enrolled. Both transient elastography and two-dimensional shear-wave elastography showed good performance for the diagnosis of advanced fibrosis [area under the receiver operating characteristic curve (AUROC) = 0.93 and 0.90, respectively]. The diagnostic performance of Vi.PLUS for the presence of both ballooning grade ≥ 1 and lobular inflammation ≥ 1 was good with an AUROC of 0.72. A score based on Vi.PLUS, aspartate aminotransferase, and sound speed plane-wave US [viscosity-aspartate aminotransferase-speed of sound MASH ultrasound score (VAS-MASH-US score)] had a good accuracy for the diagnosis of MASH (AUROC = 0.75). VAS-MASH-US score > 0.6 showed a good sensitivity for MASH diagnosis (79.0%). According to decision curve analysis, the application of the VAS-MASH-US score would lead to a more accurate selection of patients who are candidates to undergo liver biopsy and would reduce the need for invasive procedures for patients at low risk of MASH.

Conclusion: Multiparametric US allows the non-invasive assessment of steatosis, inflammation, and fibrosis in patients with MASLD. Liver viscosity improved the capability of non-invasively identifying patients with MASH.