Liguori Antonio, Ainora Maria E, Di Gialleonardo Luca, Viceconti Nicholas, Petrucci Lucrezia, Esposto Giorgio, Giustiniani Maria C, Mignini Irene, Borriello Raffaele, Galasso Linda, Paratore Mattia, Garcovich Matteo, Riccardi Laura, Pompili Maurizio, Grieco Antonio, Gasbarrini Antonio, Miele Luca, Zocco Maria A
Unità di Medicina Interna e Trapianto di Fegato, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome 00168, Italy.
CEMAD, Centro Malattie Apparato Digerente, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome 00168, Italy.
World J Gastroenterol. 2025 Jul 7;31(25):105518. doi: 10.3748/wjg.v31.i25.105518.
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.
To investigate the performance of different ultrasound (US)-based techniques for the non-invasive assessment of liver fibrosis, steatosis, and inflammation in these patients.
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.
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.
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.
在代谢功能障碍相关脂肪性肝病（MASLD）中，识别有进展为代谢功能障碍相关脂肪性肝炎（MASH）高风险的患者具有挑战性。
研究不同基于超声（US）的技术对这些患者肝纤维化、脂肪变性和炎症进行无创评估的性能。
我们收集了2019年1月至2021年12月期间因疑似MASLD接受肝活检的连续患者的数据。在活检前，使用Aixplorer MACH 30系统测量二维剪切波弹性成像、声速平面波超声、衰减平面波超声、粘度平面波超声（Vi.PLUS），以及来自FibroScan的瞬时弹性成像和受控衰减参数。
共纳入120名参与者。瞬时弹性成像和二维剪切波弹性成像在诊断晚期纤维化方面均表现良好[受试者操作特征曲线下面积（AUROC）分别为0.93和0.90]。Vi.PLUS对气球样变分级≥1和小叶炎症≥1的诊断性能良好，AUROC为0.72。基于Vi.PLUS、天冬氨酸氨基转移酶和声速平面波超声的评分[粘度-天冬氨酸氨基转移酶-声速MASH超声评分（VAS-MASH-US评分）]对MASH的诊断具有良好的准确性（AUROC = 0.75）。VAS-MASH-US评分>0.6对MASH诊断具有良好的敏感性（79.0%）。根据决策曲线分析，VAS-MASH-US评分的应用将导致更准确地选择进行肝活检的患者，并减少对MASH低风险患者进行侵入性检查的需求。
多参数超声可对MASLD患者的脂肪变性、炎症和纤维化进行无创评估。肝脏粘度提高了无创识别MASH患者的能力。
