Noureddin Mazen, Truong Emily, Gornbein Jeffrey A, Saouaf Rola, Guindi Maha, Todo Tsuyoshi, Noureddin Nabil, Yang Ju Dong, Harrison Stephen A, Alkhouri Naim
Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, California, United States; Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, United States; Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, California, United States; Cedars-Sinai Medical Center, Los Angeles, California, United States.
Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, United States; Cedars-Sinai Medical Center, Los Angeles, California, United States.
J Hepatol. 2022 Apr;76(4):781-787. doi: 10.1016/j.jhep.2021.11.012. Epub 2021 Nov 17.
BACKGROUND & AIMS: Among the large population of patients with non-alcoholic fatty liver disease (NAFLD), identifying those with fibrotic non-alcoholic steatohepatitis (Fibro-NASH) is a clinical priority, as these patients are at the highest risk of disease progression and will benefit most from pharmacologic treatment. MRI-based proton density fat fraction (MRI-PDFF) and MR elastography (MRE) can risk-stratify patients with NAFLD by assessing steatosis and fibrosis, respectively. We developed a highly specific MRI-based score to identify patients with Fibro-NASH.
This analysis included derivation (n = 103) and validation (n = 244) cohorts of patients who underwent MRI, liver biopsy, transient elastography, and laboratory testing for NAFLD from 2016-2020 in 2 tertiary care centers. To identify Fibro-NASH, a formula was developed based on MRI-PDFF, MRE, and a third variable with highest balanced accuracy per logistic regression. The MRI-aspartate aminotransferase (MAST) score was created and compared to NAFLD fibrosis (NFS), Fibrosis-4 (FIB-4), and FibroScan-aspartate aminotransferase (FAST) scores.
The MAST score demonstrated high performance and discrimination in the validation cohort (AUC 0.93; 95% CI 0.88-0.97). In the validation cohorts, the 90% specificity cut-off of 0.242 corresponded to a sensitivity of 75.0%, positive predictive value (PPV) of 50.0% and negative predictive value (NPV) of 96.5%, whereas the 90% sensitivity cut-off of 0.165 corresponded to a specificity of 72.2%, PPV of 29.4%, and NPV of 98.1%. Compared to NFS and FIB-4, MAST resulted in fewer patients having indeterminate scores and an overall higher AUC. Compared to FAST, MAST exhibited a higher AUC and overall better discrimination.
The MAST score is an accurate, MRI-serum-based score that outperforms previous scores in non-invasively identifying patients at higher risk of Fibro-NASH.
Identifying patients with non-alcoholic steatohepatitis and significant fibrosis - who need treatment and are at risk of clinical liver-related outcomes - is a clinical priority. We developed a more accurate score using MRI-based technologies and a laboratory blood test (aspartate aminotransferase) that outperforms previous non-invasive scores for the identification of patients at higher risk of liver disease progression.
在大量非酒精性脂肪性肝病（NAFLD）患者中，识别出患有纤维化非酒精性脂肪性肝炎（Fibro-NASH）的患者是临床工作的重点，因为这些患者疾病进展风险最高，且最能从药物治疗中获益。基于磁共振成像（MRI）的质子密度脂肪分数（MRI-PDFF）和磁共振弹性成像（MRE）分别通过评估脂肪变性和纤维化情况，对NAFLD患者进行风险分层。我们开发了一种基于MRI的高特异性评分系统，用于识别Fibro-NASH患者。
该分析纳入了2016年至2020年在2家三级医疗中心接受MRI、肝活检、瞬时弹性成像及NAFLD实验室检测的患者队列，其中推导队列（n = 103），验证队列（n = 244）。为识别Fibro-NASH，基于MRI-PDFF、MRE以及逻辑回归中平衡准确度最高的第三个变量制定了一个公式。创建了MRI-天冬氨酸转氨酶（MAST）评分，并与NAFLD纤维化（NFS）评分、纤维化-4（FIB-4）评分和FibroScan-天冬氨酸转氨酶（FAST）评分进行比较。
MAST评分在验证队列中表现出高性能和良好的区分度（曲线下面积[AUC]为0.93；95%置信区间[CI]为0.88 - 0.97）。在验证队列中，90%特异性的截断值为0.242，对应灵敏度为75.0%，阳性预测值（PPV）为50.0%，阴性预测值（NPV）为96.5%；而90%灵敏度的截断值为0.165，对应特异性为72.2%，PPV为29.4%，NPV为98.1%。与NFS和FIB-4相比，MAST评分使不确定评分的患者更少，且总体AUC更高。与FAST相比，MAST表现出更高的AUC和总体更好的区分度。
MAST评分是一种准确的、基于MRI和血清的评分系统，在非侵入性识别Fibro-NASH高风险患者方面优于以往的评分系统。
识别出患有非酒精性脂肪性肝炎且有显著纤维化的患者（这些患者需要治疗且有临床肝脏相关结局的风险）是临床工作的重点。我们利用基于MRI的技术和一项实验室血液检测（天冬氨酸转氨酶）开发了一种更准确的评分系统，在识别肝病进展高风险患者方面优于以往的非侵入性评分系统。
