An Optimized Strategy Based on Conventional Ultrasound for Diagnosing Metabolic Dysfunction-Associated Steatotic Liver Disease
Xiongcai Feng,
Junzhao Ye,
Hong Deng,
Xin Li,
Lishu Xu,
Shiting Feng,
Zhi Dong,
Bing Liao,
Zhiyong Dong,
Bihui Zhong
Affiliations
Xiongcai Feng
Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, No. 58 Zhongshan II Road, Yuexiu District, Guangzhou 510000, China
Junzhao Ye
Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, No. 58 Zhongshan II Road, Yuexiu District, Guangzhou 510000, China
Hong Deng
Department of Infectious Diseases, The Third Affiliated Hospital, Sun Yat-sen University, No. 600 Tianhe Road, Tianhe District, Guangzhou 510080, China
Xin Li
Department of Gastroenterology, The Tenth Affiliated Hospital of Southern Medical University (Dongguan People’s Hospital), No. 78 Wandao Road, Wanjiang District, Dongguan 523059, China
Lishu Xu
Department of Geriatrics, Guangdong Provincial People’s Hospital, No. 106 Zhongshan II Road, Yuexiu District, Guangzhou 510000, China
Shiting Feng
Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, No. 58 Zhongshan II Road, Yuexiu District, Guangzhou 510000, China
Zhi Dong
Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, No. 58 Zhongshan II Road, Yuexiu District, Guangzhou 510000, China
Bing Liao
Department of Pathology, The First Affiliated Hospital, Sun Yat-sen University, No. 58 Zhongshan II Road, Yuexiu District, Guangzhou 510000, China
Zhiyong Dong
Department of Bariatric Surgery, The First Affiliated Hospital, Jinan University, No. 613 West Huangpu Avenue, Tianhe District, Guangzhou 510080, China
Bihui Zhong
Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, No. 58 Zhongshan II Road, Yuexiu District, Guangzhou 510000, China
The inherent drawbacks of the conventional B-mode ultrasound for metabolic dysfunction-associated steatotic liver disease (MASLD) are poorly understood. We aimed to investigate the impact factors and optimize the screening performance of ultrasound in MASLD. In a prospective pilot cohort recruited from July 2020 to January 2022, subjects who had undergone magnetic resonance imaging-based proton density fat fraction (MRI-PDFF), ultrasound, and laboratory test-based assessments were included in the deprivation cohort. A validation cohort including 426 patients with liver histologic assessments from five medical centers in South China was also recruited. A total of 1489 Chinese subjects were enrolled in the deprivation cohort, and ultrasound misdiagnosed 62.2% of the non-MASLD patients and failed to detect 6.1% of the MASLD patients. The number of metabolic dysfunction components and the alanine aminotransferase (ALT) level were associated with a missed diagnosis by ultrasound (OR = 0.67, 95% CI 0.55–0.82 p p = 0.003, respectively). Compared with ultrasound alone, the new strategy based on ultrasound, in combination with measurements of the number of metabolic dysfunction components and ALT and uric acid levels, significantly improved the AUROC both in the research cohort and the validation cohort (0.66 vs. 0.84, 0.83 vs. 0.92, respectively). The number of metabolic dysfunction components and ALT and uric acid levels improved the screening efficacy of ultrasound for MASLD.
