MRE plus FIB-4 bests MAST, FAST to ‘rule in or rule out’ stage 2 fibrosis in NAFLD
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LONDON — Magnetic resonance elastography in combination with the fibrosis-4 index was a better predictor of significant fibrosis in patients with nonalcoholic fatty liver disease vs. other noninvasive techniques, noted a presenter here.
“NALFD patients with significant fibrosis — defined as those who have stage 2 or higher — are candidates for pharmacological treatments,” Rohit Loomba, MD, MHSc, director of hepatology and the NAFLD Research Center at UC San Diego School of Medicine, told attendees at the International Liver Congress. “Considering high screen failure rates, it’s difficult to identify those patients, so we often do liver biopsies to identify them.”
He added: “As an alternative to invasive liver biopsies, several noninvasive measures have been assessed. We have looked at FIB-4 index, liver stiffness by [vibration controlled transient elastography], MR elastography. However, we have also looked at a combination of these tests developed as panels: You take a serum test and then you take an elastography-based method to see together if they might serve you better. To that end, there are three that have been looked at: MEFIB, [magnetic resonance imaging-aspartate aminotransferase (MAST)] and [FibroScan- aspartate aminotransferase (FAST) scores].”
To ascertain the diagnostic accuracies of the MEFIB, MAST and FAST scores, Loomba and colleagues conducted a head-to-head study among 563 biopsy-confirmed NAFLD patients (mean age, 56.5 years; 49% men) undergoing contemporaneous MRE, MRI proton density fat fraction and FibroScan. Loomba noted that each model was categorized into three classes as rule-in, indeterminate and rule-out, using rule-in/-out criteria.
According to study results, MEFIB was superior to MAST and FAST for predicting significant fibrosis (P < .001). Although the positive predictive value of MEFIB (95.3%) was higher than FAST (83.5%, P = .001), it was similar to MAST (90%) using the rule-in criteria.
Researchers also reported that the rule-in criteria for MEFIB covered more of the study population than MAST (34.1% vs. 26.6%; P = .006). In addition, negative predictive value of MEFIB (90.1%) was higher than either MAST (69.6%) or FAST (71.8%) using the rule-out criteria (both P < 0.001).
“MEFIB demonstrated a highly reliable and acceptable ability to rule in or rule out significant liver fibrosis defined as stage 2 or higher and exhibited a better positive predictive value and diagnostic accuracy compared to MAST or FAST,” Loomba said. “MEFIB, MAST or FAST offer acceptable diagnostic accuracies, and since all of these tests may not be available at each site, I think potentially you can utilize all three of them — depending on what's available — with the understanding that the diagnostic accuracies might be different.”
He added: “I would consider a two-step strategy with FIB-4 of 1.6 or higher and then doing an MR elastography. If you are concerned about costs, then that would be one way of solving that problem. And you could still consider using FAST in those patients, if you were to still risk stratify those that are below 1.6, which is one way of addressing the cost issue.”
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Loomba R. Abstract OS098. Presented at: International Liver Congress; June 22-26, 2022; London (hybrid meeting).
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