Multifrequency MR elastography for grading inflammation in metabolic dysfunction-associated steatotic liver disease: a pilot study.

Abstract

Background: Noninvasive grading of liver inflammation in metabolic dysfunction-associated steatotic liver disease (MASLD) remains an unmet clinical need.

Purpose: To evaluate the diagnostic performance of multifrequency MR elastography (MMRE) for grading liver inflammation and diagnosing metabolic dysfunction-associated steatohepatitis (MASH).

Materials and methods: In this prospective, single-site study, participants underwent MMRE at 30, 40, and 60 Hz on a 3T system. Multifrequency dispersion coefficient (α), storage modulus ( $G\text{'}$ ), loss modulus ( $G"$ ), and magnitude of the shear modulus ( $\left|G^{*}\right|$ ) were computed. The reference standard was histopathological analysis of needle biopsy specimens. The MASLD activity score was computed to assign MASH status. Univariate and multivariable correlation and areas under the receiver operating characteristic curve (AUCs) were assessed.

Results: Of the 72 participants enrolled, 60 (12 healthy, 48 MASLD) were analyzable. Correlations of α, $G\text{'}$ , $G"$ , and $\left|G^{*}\right|$ with lobular inflammation grades were ρ = -0.62, P < .001; ρ = 0.46, P < .001; ρ = 0.39, P < .01; and ρ = 0.44, P < .001; and the corresponding correlations with ballooning ρ = -0.42, P < .001; ρ = 0.42, P < .001; ρ = 0.40, P < .001; and ρ = 0.41, P < .001. The correlation between α and lobular inflammation remained after adjusting for steatosis, ballooning, and fibrosis ( $\beta$ = -0.06, P < .001); and with ballooning after adjusting for steatosis, lobular inflammation, and fibrosis ( $\beta$ = -0.02, P < .01). AUCs of α were 0.85, 0.96, and 0.94, respectively, for distinguishing lobular inflammation grades 0 vs ≥1, ≤1 vs ≥2, and ≤2 vs 3; 0.84 and 0.78 for distinguishing ballooning grades 0 vs ≥1 and ≤1 vs 2; and 0.81 to 0.85 for diagnosing MASH.

Conclusion: The multifrequency dispersion coefficient α was associated with histologic inflammation and should be further evaluated with external validation as a possible clinical marker in MASLD.