Table 6.
Targets of different non-invasive techniques (selection) and suggested thresholds for ruling out/in certain features of MASLD
| Non-invasive Test | Biological processes reflected | Rule-out cut-off | Rule-in cut-off | Prediction of liver-related outcomes |
|---|---|---|---|---|
| Primary target: Hepatic steatosis | ||||
| US scan – standard | Lipid content | N/A | N/A | + |
| VCTE: CAP (Controlled attenuation parameter) [167] | Lipid content | S1: 248 dB/m S2: 268 dB/m S3: 280 dB/m |
? | |
| MRI – MRI-PDFF ([164]) | Lipid content | S1: 5% S2: 11-18% S3: 16-23% |
+ | |
| Primary target: Hepatic fibrosis | ||||
| AST/ALT ratio [153, 176] | Stress to hepatocytes | F3: 0.8 | F3: 1.0 | + |
| FIB-4 [141, 159, 176] | Stress to hepatocytes, hypersplenism | F2: 0.66-0.89 F3: 1.3 |
F2: 2.67 F3: 2.67 |
++ |
| APRI [159, 176] | Stress to hepatocytes, hypersplenism | F3: 0.5 | F3: 1.5 | ++ |
| NFS [139, 176] | Stress to hepatocytes, hypersplenism, metabolic burden | F3: -1.455 | F3: 0.676 | ++ |
| ELF [148, 177] | Collagen metabolism | F3: 7.7 | F3: 9.8 | +++ |
| ADAPT [150] | Collagen metabolism, hypersplenism, metabolic burden | F3: 4.46 | F3: 7.15 | ? |
| VCTE: LSM (liver stiffness) [157, 176, 177] | Fibrosis, extracellular volume fraction | F3: 8 kPa | F3: 12 kPa | +++ |
| US – 2D-SWE [156] | Fibrosis, extracellular volume fraction | F3: 8 kPa | F3: 10.5 kPa | +++ |
| MRI – MRE [171, 178] | Fibrosis, extracellular volume fraction | F2: 3.14 kPa F3: 3.53 kPa F4: 4.45 kPa |
+++ | |
| MEFIB [170, 171] | Stress to hepatocytes, fibrosis, hypersplenism | F2: MRE <3.3 kPa and FIB-4 <1.6 | F2: MRE ≥3.3 kPa and FIB-4 ≥1.6 | +++ |
| Primary target: “At-risk MASH” | ||||
| FAST [169, 176] | Stress to hepatocytes, fibrosis, lipid content | 0.35 | 0.67 | ++ |
| MAST [168] | Stress to hepatocytes, fibrosis, lipid content | 0.165 | 0.242 | ++ |
| Corrected T1 [161] | Extracellular volume fraction, (fibrosis) | 825 ms | 875 ms | ++ |
| NIS2+ [179] | Stress to hepatocytes, fibrosis, extracellular matrix remodelling | 0.46 | 0.68 | ? |
ADAPT, age, presence of diabetes, PRO‐C3, and platelet count; ALT, alanine aminotransferase, APRI, AST to platelet ratio index; AST, aspartate aminotransferase; CAP, controlled attenuation parameter; ELF, enhanced liver fibrosis; F1-F4, fibrosis stage (F2: moderate fibrosis, F3: severe fibrosis, F4: cirrhosis); FAST, FibroScan-AST, MAST, MRI-AST; MEFIB, MRE combined with FIB-4, MRE, magnetic resonance elastography; NFS, NAFLD fibrosis score; PDFF, proton density fat fraction; S1–S3, stage of steatosis (S1: mild (<10% hepatocytes), S2: moderate (10–30% hepatocytes), S3: severe (>30% hepatocytes) steatosis); SWE, shear-wave elastography; VCTE, vibration-controlled transient elastography; US, ultrasound.
The predictive value of the test/procedure for liver-related outcomes (e.g. cirrhosis complications, HCC, liver-related death) is qualitatively depicted (+ low, ++ moderate, +++ high, ? unknown).
Merged cells represent non-invasive techniques with single cut-offs.