08178772

July 09, 2025, 08:33

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### Review of the Article “Multiparametric ultrasound for non-invasive assessment of liver steatosis, fibrosis, and inflammation in metabolic dysfunction-associated steatotic liver disease” published in the World Journal of Gastroenterology This article represents a significant advancement in the non-invasive diagnosis of metabolic dysfunction-associated steatotic liver disease (MASLD) and offers valuable insights for clinical practice. #### Clinical Application Value The study introduces a non-invasive assessment method based on multiparametric ultrasound, which holds great significance for clinical practice. Given the large number of MASLD patients, traditional liver biopsy is not only costly but also associated with sampling errors and risks of complications. The introduction of multiparametric ultrasound provides clinicians with a safer and more convenient diagnostic tool, effectively reducing the need for liver biopsies and minimizing patient discomfort and medical costs. #### Innovation For the first time, this study compares viscosity measurements (Vi.PLUS) with the histopathological features of MASLD and finds that viscosity is closely related to the degree of inflammation and ballooning in MASH. This finding offers a new perspective for the non-invasive diagnosis of MASLD and paves the way for future research and clinical applications. #### Methodological Rigor The study employs a single-center, prospective, cross-sectional design with 120 patients, all of whom underwent liver biopsy as the reference standard. This rigorous study design and methodology ensure the reliability and scientific validity of the results. #### Practicality of the Results The study demonstrates that the VAS-MASH-US score, based on multiparametric ultrasound, has good sensitivity and specificity for diagnosing MASH. This scoring system provides clinicians with a practical tool to better identify high-risk patients who need liver biopsy, while reducing unnecessary invasive examinations for low-risk patients. #### Limitations of the Study Despite the significant findings, the study has some limitations. For example, it is a single-center study with a relatively small sample size, and the results have not yet been validated in an independent cohort. Additionally, differences in ultrasound equipment and techniques across centers may affect the generalizability of the results. #### Implications for Future Research This study provides new ideas and methods for the non-invasive diagnosis of MASLD, but further research is needed to validate these findings. For instance, multicenter studies in larger populations could verify the universality and accuracy of the VAS-MASH-US score. Moreover, exploring the combination of other non-invasive techniques with multiparametric ultrasound could further improve the diagnostic accuracy of MASLD. In summary, this article represents an important step forward in the non-invasive diagnosis of MASLD. Its innovation and practicality are commendable. It is hoped that more research will be conducted in the future to further refine this field and provide better medical services for MASLD patients.

First, thank you very much for your professional comments on the article published in World Journal of Gastroenterology. Second, we read your comments with great interest. You are welcome to format your valuable comments into a Letter to the Editor and submit it online to World Journal of Gastroenterology at https://www.f6publishing.com. There are no restrictions on the number of words, figures (color, B/W) or authors for a Letter to the Editor. In addition, the article processing charge will be exempted for this Letter to the Editor. As with all articles published by the Baishideng Publishing Group, the Letter to the Editor will be published online after completing peer review. The guidelines for a Letter to the Editor can be found at: https://www.wjgnet.com/bpg/GerInfo/219. Finally, we look forward to receiving your high-quality Letter to the Editor, which will promote academic communication and lead the development of this discipline.

08628847

July 06, 2025, 12:16

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This study presents a comprehensive investigation into the use of multiparametric ultrasound (US) for the non-invasive assessment of liver steatosis, fibrosis, and inflammation in patients with metabolic dysfunction-associated steatotic liver disease (MASLD). The authors employed various advanced ultrasound techniques, including 2D shear-wave elastography (SWE), sound speed and attenuation imaging, and viscosity plane-wave ultrasound (Vi.PLUS), alongside traditional methods like FibroScan. The study's findings are promising, demonstrating that multiparametric ultrasound can effectively assess liver conditions such as fibrosis and steatosis, and even disease activity related to inflammation and ballooning. The diagnostic performance of the viscosity index (Vi.PLUS) and the VAS-MASH-US score was found to be good, especially for identifying patients with metabolic dysfunction-associated steatohepatitis (MASH). This approach could help reduce unnecessary liver biopsies, thereby minimizing costs and procedural risks, which is a significant clinical advantage.

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