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©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
Multiparametric ultrasound for non-invasive assessment of liver steatosis, fibrosis, and inflammation in metabolic dysfunction-associated steatotic liver disease
Antonio Liguori, Maria E Ainora, Luca Di Gialleonardo, Nicholas Viceconti, Lucrezia Petrucci, Giorgio Esposto, Maria C Giustiniani, Irene Mignini, Raffaele Borriello, Linda Galasso, Mattia Paratore, Matteo Garcovich, Laura Riccardi, Maurizio Pompili, Antonio Grieco, Antonio Gasbarrini, Luca Miele, Maria A Zocco
Antonio Liguori, Nicholas Viceconti, Lucrezia Petrucci, Maurizio Pompili, Antonio Grieco, Luca Miele, Unità di Medicina Interna e Trapianto di Fegato, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome 00168, Italy
Maria E Ainora, Luca Di Gialleonardo, Giorgio Esposto, Irene Mignini, Raffaele Borriello, Linda Galasso, Mattia Paratore, Matteo Garcovich, Laura Riccardi, Antonio Gasbarrini, Maria A Zocco, CEMAD, Centro Malattie Apparato Digerente, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome 00168, Italy
Maria C Giustiniani, Dipartimento di Scienze Della Salute Della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome 00168, Italy
Author contributions: Zocco MA and Miele L contributed to conceptualization; Liguori A, Ainora ME, Miele L, and Zocco MA contributed to methodology; Liguori A contributed to formal analysis; Liguori A, Ainora ME, Di Gialleonardo L, Petrucci L, Viceconti N, Mignini I, Borriello R, Galasso L, Garcovich M, Giustiniani MC, and Paratore M contributed to the investigation; Liguori A, Di Gialleonardo L, Viceconti N, and Petrucci L contributed to data curation; Liguori A and Ainora ME contributed to writing the original draft; Liguori A, Ainora ME, Esposto G, Miele L, and Zocco MA contributed to writing and reviewing; Liguori A, Ainora ME, Esposto G, Miele L, and Zocco MA contributed to editing; Miele L, Pompili M, Zocco MA, Grieco A, Riccardi L, and Gasbarrini A contributed to supervision; Gasbarrini A, Miele L, and Zocco MA contributed to funding acquisition; All authors read and approved the final version of the manuscript.
Institutional review board statement: Protocol was approved by local ethic committee [Prot. 20048/19 (28519/19) ID: 2576].
Clinical trial registration statement: Protocol was registered on clinical trial (No. NCT04371042).
Informed consent statement: Written informed consent was obtained by every patient.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Data sharing statement: All article data are available in the paper.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Maria A Zocco, MD, PhD, Professor, CEMAD, Centro Malattie Apparato Digerente, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Gemelli 1, Rome 00168, Italy.
mariaassunta.zocco@unicatt.it
Received: February 7, 2025
Revised: March 27, 2025
Accepted: June 10, 2025
Published online: July 7, 2025
Processing time: 147 Days and 23.1 Hours
BACKGROUND
In metabolic dysfunction-associated steatotic liver disease (MASLD) the identification of patients at high risk of evolution to metabolic dysfunction-associated steatohepatitis (MASH) is challenging.
AIM
To investigate the performance of different ultrasound (US)-based techniques for the non-invasive assessment of liver fibrosis, steatosis, and inflammation in these patients.
METHODS
We collected data from consecutive patients who underwent liver biopsy for suspected MASLD between January 2019 and December 2021. Two-dimensional shear-wave elastography, sound speed plane-wave US, attenuation plane-wave US, viscosity plane-wave US (Vi.PLUS) using Aixplorer MACH 30 system, and transient elastography and controlled attenuation parameter from FibroScan were measured before biopsy.
RESULTS
A total of 120 participants were enrolled. Both transient elastography and two-dimensional shear-wave elastography showed good performance for the diagnosis of advanced fibrosis [area under the receiver operating characteristic curve (AUROC) = 0.93 and 0.90, respectively]. The diagnostic performance of Vi.PLUS for the presence of both ballooning grade ≥ 1 and lobular inflammation ≥ 1 was good with an AUROC of 0.72. A score based on Vi.PLUS, aspartate aminotransferase, and sound speed plane-wave US [viscosity-aspartate aminotransferase-speed of sound MASH ultrasound score (VAS-MASH-US score)] had a good accuracy for the diagnosis of MASH (AUROC = 0.75). VAS-MASH-US score > 0.6 showed a good sensitivity for MASH diagnosis (79.0%). According to decision curve analysis, the application of the VAS-MASH-US score would lead to a more accurate selection of patients who are candidates to undergo liver biopsy and would reduce the need for invasive procedures for patients at low risk of MASH.
CONCLUSION
Multiparametric US allows the non-invasive assessment of steatosis, inflammation, and fibrosis in patients with MASLD. Liver viscosity improved the capability of non-invasively identifying patients with MASH.
Core Tip: This article provided further insights into the performance of different ultrasound-based techniques for non-invasive multiparametric assessment of liver fibrosis, steatosis, and inflammation in patients with metabolic dysfunction-associated steatotic liver disease. We found that among the analyzed parameters, liver viscosity was associated with the degree of inflammation and ballooning and allows together with ultrasound attenuation and biochemical parameters the identification of patients with metabolic dysfunction-associated steatohepatitis with good reliability. This could help to distinguish patients at high risk from those at low risk, reducing the number of liver biopsies in patients at low risk of metabolic dysfunction-associated steatohepatitis.
