The prevalence of MASH is increasing worldwide. A model created at the Cleveland Clinic Lerner College of Medicine projects that the number of Metabolic dysfunction associated steatotic liver disease (MASLD) cases is going to rise by 23% by 2050 in the US, and the proportion of patients with MASH will rise from 20% to 21.8%.

MASH represents a significant challenge in clinical hepatology, requiring histological confirmation for diagnosis. A recent multicenter study introduced the MR–MASH score, an innovative MRI-based tool aimed at noninvasively identifying MASH in patients with MASLD.

David Martí-Aguado, MD, and colleagues conducted a prospective study involving 317 patients with biopsy-confirmed MASLD and contemporaneous MRI assessments. The study included a discovery cohort comprising 194 patients from Spain and Portugal and a validation cohort from the US and Spain.

The researchers performed histologic evaluations with the Nonalcoholic Steatohepatitis Clinical Research Network system, defining MASH by the presence of steatosis, lobular inflammation, and ballooning, along with a Non-Alcoholic Fatty Liver Disease Activity Score (NAS) of 4 or greater. The investigators tested and validated the MR–MASH score, which combines Proton Density Fat Fraction and waist circumference, across different MRI protocols.

MASH presented in 51% of patients (n=99) in the derivation cohort. The MR–MASH score demonstrated a high accuracy in identifying MASH, with an area under the curve (AUC) of 0.88 and a strong correlation with NAS (r=0.69). Sensitivity and specificity were robust at both lower and upper cut-offs, with 88% sensitivity and 86% negative predictive value, and 92% specificity and 87% positive predictive value (PPV), respectively.

Validation results were consistent, showing an AUC of 0.86, 91% sensitivity, and 87% specificity. A two-step screening approach utilizing the MR–MASH score following indeterminate-high FIB-4 or transient elastography readings yielded an 83%-84% PPV for MASH identification.

Of note, the MR–MASH score significantly out performed the FibroScan-AST score ( P<0.001). The MR–MASH score presents a clinically valuable, noninvasive diagnostic tool for MASH, facilitating early identification and management of patients at risk of disease progression. This advancement holds potential for enhancing patient outcomes and optimizing resource allocation in hepatology practices. Further research may solidify its role in routine clinical screening and monitoring protocols.