MRI-based (MAST) score accurately identifies patients with NASH and significant fibrosis,Journal of Hepatology

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MRI-based (MAST) score accurately identifies patients with NASH and significant fibrosis
Journal of Hepatology ( IF 26.8 ) Pub Date : 2021-11-17 , DOI: 10.1016/j.jhep.2021.11.012
Mazen Noureddin ₁ , Emily Truong ₂ , Jeffrey A Gornbein ₃ , Rola Saouaf ₄ , Maha Guindi ₄ , Tsuyoshi Todo ₅ , Nabil Noureddin ₆ , Ju Dong Yang ₁ , Stephen A Harrison ₇ , Naim Alkhouri ₈

Affiliation

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.
Department of Medicine, University of California Los Angeles, Los Angeles, California, United States.
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.
Division of Gastroenterology and Hepatology, University of California San Diego, San Diego, California, United States.
Pinnacle Research Center, Oxford University, Oxford, United Kingdom.
Arizona Liver Health, Phoenix, Arizona, United States.

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.

Methods

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.

Results

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.

Conclusion

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.

Lay summary

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.

中文翻译：

基于 MRI (MAST) 的评分可准确识别患有 NASH 和显着纤维化的患者

背景与目标

在大量非酒精性脂肪性肝病 (NAFLD) 患者中，识别那些患有纤维化非酒精性脂肪性肝炎 (Fibro-NASH) 的患者是临床重点，因为这些患者疾病进展的风险最高，并且受益最多从药物治疗。基于 MRI 的质子密度脂肪分数 (MRI-PDFF) 和 MR 弹性成像 (MRE) 可以通过分别评估脂肪变性和纤维化对 NAFLD 患者进行风险分层。我们开发了一种高度特异性的基于 MRI 的评分来识别 Fibro-NASH 患者。

方法

该分析包括推导 (n = 103) 和验证 (n = 244) 队列，这些患者在 2016-2020 年期间在 2 个三级医疗中心接受了 MRI、肝活检、瞬时弹性成像和 NAFLD 实验室检测。为了识别 Fibro-NASH，基于 MRI-PDFF、MRE 和第三个变量开发了一个公式，每个逻辑回归具有最高的平衡精度。创建 MRI-天冬氨酸氨基转移酶 (MAST) 评分并将其与 NAFLD 纤维化 (NFS)、Fibrosis-4 (FIB-4) 和 FibroScan-天冬氨酸氨基转移酶 (FAST) 评分进行比较。

结果

MAST 评分在验证队列中表现出高绩效和歧视性（AUC 0.93；95% CI 0.88-0.97）。在验证队列中，0.242 的 90% 特异性临界值对应于 75.0% 的敏感性、50.0% 的阳性预测值 (PPV) 和 96.5% 的阴性预测值 (NPV)，而 90% 的敏感性临界值0.165 对应于 72.2% 的特异性、29.4% 的 PPV 和 98.1% 的 NPV。与 NFS 和 FIB-4 相比，MAST 导致具有不确定分数和总体更高 AUC 的患者更少。与 FAST 相比，MAST 表现出更高的 AUC 和整体更好的辨别力。