Multiparametric ultrasound for non-invasive assessment of liver steatosis, fibrosis, and inflammation in metabolic dysfunction-associated steatotic liver disease

Table 2 Performance of ultrasound non-invasive diagnostic tests and VAS-MASH-US score for predicting moderate-to-severe steatosis (S ≥ 2), presence of both lobular inflammation and ballooning (inflammation ≥ 1 and ballooning ≥ 1), MASH (NAS score ≥ 4 and least 1 point at steatosis, lobular inflammation, and ballooning) and Fibrosis

Variable	Cutoff value	AUC (95%CI)	Sensitivity (%)	Specificity (%)	PPV (%)	NPV (%)	P value
Steatosis ≥ 2
CAP (dB/m)	275	0.83 (0.75-0.91)	94.5	66.0	81.2	88.6	Reference
CAP (dB/m)	3011		78.0	74.5	82.6	68.6
Att.PLUS (dB/cm/mHz)	0.44	0.60 (0.50-0.70)	89.4	31.5	45.6	82.1	< 0.01
SSp.PLUS (m/s)	1535	0.71 (0.61-0.81)	70.2	65.7	56.9	77.4	0.02
Inflammation ≥ 1 and ballooning ≥ 1
Vi.PLUS (Pa.s)	2.3	0.72 (0.59-0.86)	52.8	92.8	98.2	20.6	Reference
MASH
Vi.PLUS (Pa.s)	2.1	0.68 (0.58-0.79)	69.1	64.1	80.0	50.0	Reference
VAS-MASH-US score	0.60	0.75 (0.65-0.84)	79.0	66.7	83.1	60.4	0.14
	0.48		90.0	43.6	76.6	65.4
	0.84		30.9	90.0	86.2	38.4
Fibrosis ≥ 2
TE (kPa)	6.4	0.75 (0.65-0.83)	72.9	71.7	80.6	62.3	Reference
2D-SWE (kPa)	6.4	0.69 (0.60-0.79)	59.5	73.9	78.6	53.1	0.25
FIB-4	1.07	0.65 (0.55-0.75)	62.2	58.7	70.8	49.1	0.10
NFS	-0.97	0.69 (0.59-0.79)	55.4	78.3	80.4	52.2	0.40
Vi.PLUS (Pa.s)	2.3	0.64 (0.53-0.74)	59.5	71.7	77.2	52.4	0.04
Fibrosis ≥ 3
TE (kPa)	81		91.2	83.7	68.9	96.0	Reference
	8.4	0.93 (0.87-0.99)	85.3	91.9	80.5	94.0
	121		35.3	97.7	84.6	78.5
2D-SWE (kPa)	7.2	0.90 (0.85-0.95)	88.2	81.4	61.7	93.1	0.43
FIB-4	1.26	0.80 (0.71-0.89)	70.6	74.4	52.2	86.5	0.01
NFS	-1.12	0.83 (0.75-0.90)	88.2	73.2	56.6	94.0	0.03
Agile3 +	0.42	0.93 (0.88-0.98)	85.3	89.5	76.3	93.9	0.99
Vi.PLUS (Pa.s)	2.1	0.81 (0.74-0.89)	100	58.1	48.6	100	< 0.01

¹Cut-off from literature and World Federation for Ultrasound in Medicine and Biology guidelines.

AUC: Area under the curve; CI: Confidence interval; PPV: Positive predictive value; NPV: Negative predictive value; Att.PLUS: Attenuation plane-wave ultrasound; SSp.PLUS: Sound speed plane-wave ultrasound; 2D-SWE: Two-dimensional shear wave elastography; CAP: Controlled attenuation parameter; Vi.PLUS: Viscosity plane-wave ultrasound; MASH: Metabolic dysfunction-associated steatohepatitis; VAS-MASH-US: Viscosity-aspartate aminotransferase-speed of sound metabolic dysfunction-associated steatohepatitis ultrasound; TE: Transient elastography; FIB: Fibrosis; NFS: Non-alcoholic fatty liver disease fibrosis score; P value from DeLong test for comparing AUC