Imaging-Based Modalities for Identifying At Risk MASH. A Diagnostic Test Meta-Analysis.
Shyna Zhuoying Gunalan, Michelle Shi Ni Law, Yi Xin Kua et al.
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In 30 seconds
This systematic review and diagnostic test meta-analysis assessed imaging-based methods for identifying at-risk MASH, defined as metabolic activity score ≥4 and F ≥ 2. Twenty studies involving 9,480 participants were included. FAST had the highest sensitivity for ruling out at-risk MASH (0.871; specificity 0.567) and the highest specificity for ruling it in (0.900; sensitivity 0.441). Magnetic resonance elastography plus fibrosis-4 also showed high rule-out sensitivity (0.812), while MRI-aspartate aminotransferase had intermediate performance and cT1 accuracy varied.
Key findings
- FAST rule-out performance had sensitivity 0.871 and specificity 0.567.
- For ruling in at-risk MASH, FAST specificity was 0.900 and sensitivity was 0.441.
- Magnetic resonance elastography plus fibrosis-4 had rule-out sensitivity 0.812 and specificity 0.606; rule-in specificity was 0.872 and sensitivity 0.500.
- Head-to-head study sensitivity analysis found superior performance for FAST compared with other diagnostic methods.
Why it matters
Identifying at-risk MASH noninvasively may help distinguish patients with clinically relevant disease activity and fibrosis. The pooled results show that diagnostic performance depends on whether a test is used to rule disease in or out, so sensitivity and specificity trade-offs matter when interpreting these modalities. FAST and MRI-based approaches offer potential options, but the findings do not establish a single test as suitable for every clinical context.
What to keep in mind
The abstract does not report study-level heterogeneity or other limitations; diagnostic performance was assessed using prespecified rule-in and rule-out thresholds, and cT1 results varied.