Introduction
Metabolic dysfunction-associated steatotic liver disease (MASLD) can lead to fibrosis and cirrhosis. Assessment of fibrosis and steatosis via vibration-controlled transient elastography (VCTE) and controlled attenuation parameter (CAP) requires a dedicated device and time to obtain ≥10 reliable measurements. Automated point shear wave elastography (Auto pSWE) allows for the collection of 15 ARFI based liver stiffness measurements (LSM) together with ultrasound derived fat fraction (UDFF) based steatosis assessment in a single acquisition.
Aims & Methods
This prospective study included patients who underwent liver biopsy - mostly during bariatric surgery - at the Vienna General hospital between 11/2021 and 12/2023. Paired Auto pSWE/UDFF and VCTE/CAP assessments of LSM and hepatic steatosis were performed within ±90 days of liver biopsy.
Results
Among 134 patients (65% women, mean age: 42.6±13.3 years) with a high prevalence of obesity (mean BMI: 42.7±10.4), MASLD was the most common aetiology (88%). Median histologic fibrosis and steatosis stages were F0 and S2. 68 (51%) and 36 (27%) patients had moderate steatosis (≥S2) and significant fibrosis (≥F2) on biopsy, respectively.
With Auto pSWE, 1x15 acquisitions were as accurate as using 5x15 acquisitions. Similarly, one UDFF measurement was as accurate as 5 UDFF measurements. Auto pSWE (≥F2, AUC=0.58; ≥F3, AUC=0.96; F4, AUC=0.97) and VCTE (≥F2, AUC=0.60; F3, AUC=0.92; F4, AUC=0.93) showed moderate diagnostic accuracy for lower fibrosis stages and high diagnostic accuracy for higher fibrosis stages. There was no statistical difference between the diagnostic accuracy of UDFF (≥S1, AUC=0.79; ≥S2, AUC=0.78; S3, AUC=0.67) and CAP (≥S1, AUC=0.80; ≥S2, AUC=0.78; S3, AUC=0.66). The median time for a single VCTE measurement was 2.47 minutes (IQR 1.44-5.38), while a single composite acquisition of Auto pSWE/UDFF takes eight seconds and is integrated into standard ultrasound devices.
Conclusion
Auto pSWE and UDFF represent accurate non-invasive tests for liver fibrosis and steatosis assessment in MASLD patients, including those with severe obesity. Importantly, 15 individual LSM can be acquired using Auto pSWE simultaneously with UDFF in a single acquisition, saving valuable time without the need for a dedicated device.
Disclosure
N.D. none to declare.
L.N. none declared.
M.S. none declared.
B.H. none declared.
L.H. none to declare.
L.F. none to declare.
M.J. has served as a speaker and consultant for Gilead Sciences and has received travel support from Gilead Sciences.
G.S. received travel support from Gilead.
Lo.H. none to declare.
L.F. none to declare.
L.B. none to declare
D.M.F. has no conflict of interest.
M.T. received speaker fees from BMS, Falk Foundation, Gilead, Intercept, Jannsen, Madrigal, MSD, and Roche; he advised for AbbVie, Albireo, BiomX, Boehringer Ingelheim, Cymabay, Falk Pharma GmbH, Genfit, Gilead, Hightide, Intercept, Janssen, MSD, Novartis, Phenex, Pliant, Rectify, Regulus, Siemens, and Shire. He further received travel support from AbbVie, Falk, Gilead, Intercept, and Jannsen and research grants from Albireo, Alnylam, Cymabay, Falk, Gilead, Intercept, MSD, Takeda and UltraGenyx. He is also a co-inventor of patents on the medical use of norUDCA filed by the Medical Universities of Graz and Vienna.
J.J. none declared.
B.M. received a speaker fee from Astellas Pharma
L.G. none declared.
F.B.L. none declared.
M.M. none declared.
G.P. none declared.
T.R. received grant support from AbbVie, Boehringer-Ingelheim, Gilead, Gore, Intercept, MSD, Myr Pharmaceuticals, Philips Healthcare, Pliant, and Siemens; speaking honoraria from AbbVie, Gilead, Gore, Intercept, Roche, MSD; consulting/advisory board fee from AbbVie, Bayer, Boehringer-Ingelheim, Gilead, Intercept, MSD, Siemens; and travel support from AbbVie, Boehringer-Ingelheim, Gilead and Roche.
D.B. received grant support from Gilead; travel support from Siemens, AbbVie, and Gilead; and speaking honoraria from AbbVie, Röntgen Eisenstadt and Siemens.
