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.