Noninvasive liver fibrosis assessment in metabolic dysfunction-associated steatotic liver disease

Table 2 Parameters for noninvasive assessment of advanced fibrosis in metabolic dysfunction-associated steatotic liver disease

NIM	Rule-in cutoff	Rule-out cutoff	AUROC1	Strengths and limitations
Biomarkers
APRI	< 0.5	> 1.5	0.74	False positive in patients with alternative causes of thrombocytopenia
FIB-4	< 1.32; < 1.67	≥ 2.67; ≥ 3.483	0.84	No added cost; low accuracy in patients younger than 35 years; low specificity in those older than 65 years
NFS	< -1.44	≥ 0.672	0.82	No added cost; not accurate in age < 35 years, people with obesity and type 2 diabetes Restricted use to MASLD
ELF	< 7.7; < 7.73	≥ 9.8; ≥ 11.33	0.83	Cost and not widely available; less useful for early fibrosis
Imaging techniques
VCTE	< 8 kPa; < 8 kPa3	≥ 12 kPa; ≥ 20 kPa3	0.9	Point of care, possibility of steatosis degree evaluation; necessity of specific device; confounded by active hepatitis, food intake, congestive heart failure, biliary obstruction, amyloidosis, ascites; less applicable and reliable in severe obesity (especially with M probe)
pSWE (ARFI)	< 1.3 m/second	> 2.1 m/second	0.8-0.9	Integration into conventional ultrasound systems, which enables a comprehensive evaluation of the liver at the same time; cut points not well validated; Probably affected by the same confounders as VCTE, though the success rate is higher than VCTE in obese patients
2D-SWE	< 8 kPa	> 12 kPa	0.80-0.98	Integration into conventional ultrasound systems, which enables a comprehensive evaluation of the liver at the same time; cut points not well validated; probably affected by the same confounders as VCTE
MRE	< 2.55 kPa; < 3 kPa3	≥ 3.63kPa; ≥ 5 kPa3	0.89-0.96	Superior performance in detecting early-stage fibrosis; integration into routine liver MRI allows both fibrosis staging and surveillance of other liver pathologies, such as HCC; cost, not widely available; probably affected by the same confounders as VCTE and iron content; some patients may have contraindications to magnetic resonance imaging or have claustrophobia

¹For F3-F4.

²A lower cutoff of 2 can be used for patients older than 65 years.

³To rule in or rule out cirrhosis.

2D-SWE: Two-dimensional shear wave elastography; APRI: Aspartate aminotransferase to platelet ratio index; ARFI: Acoustic radiation force impulse; AUROC: Area under the curve; ELF: Enhanced liver fibrosis; FIB-4: Fibrosis-4 index; MRE: Magnetic resonance elastography; NFS: Nonalcoholic fatty liver disease fibrosis score; NIM: Noninvasive method; pSWE: Point shear-wave; VCTE: Vibration-controlled transient elastography; HCC: Hepatocellular carcinoma.