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Clinical Trial
. 2025 Jun;35(6):3599-3609.
doi: 10.1007/s00330-024-11215-3. Epub 2024 Dec 5.

Head-to-head comparison among FAST, MAST, and multiparametric MRI-based new score in diagnosing at-risk MASH

Kento Imajo  1   2   3 , Yusuke Saigusa  4 , Takashi Kobayashi  1 , Koki Nagai  2 , Shinya Nishida  2 , Nobuyoshi Kawamura  2 , Hiroyoshi Doi  2 , Michihiro Iwaki  1 , Asako Nogami  1 , Yasushi Honda  1 , Takaomi Kessoku  1   5 , Yuji Ogawa  6 , Hiroyuki Kirikoshi  7 , Shigehiro Kokubu  2 , Daisuke Utsunomiya  8 , Hirokazu Takahashi  9 , Shinichi Aishima  10 , Yoshio Sumida  11 , Satoru Saito  1 , Masato Yoneda  1 , Andrea Dennis  12 , Stella Kin  12 , Anneli Andersson  12 , Atsushi Nakajima  13
Affiliations
Clinical Trial

Head-to-head comparison among FAST, MAST, and multiparametric MRI-based new score in diagnosing at-risk MASH

Kento Imajo et al. Eur Radiol. 2025 Jun.

Abstract

Objectives: New scores were developed to identify at-risk metabolic dysfunction-associated steatohepatitis (MASH) using multiparametric MRI (mpMRI).

Materials and methods: A prospective study was conducted on 176 patients with suspected or diagnosed metabolic dysfunction-associated steatotic liver disease (MASLD) paired with an MR scan, vibration-controlled transient elastography (VCTE), and liver biopsy. Liver stiffness measurement (LSM) using magnetic resonance elastography (MRE), proton density fat fraction (PDFF), and mpMRI-based corrected T1 (cT1) were combined to develop a one-step strategy, named MPcT (MRE + PDFF + cT1, combined score), and a two-step strategy-MRE-based LSM followed by PDFF with cT1 (M-PcT, paired score) for diagnosing at-risk MASH. Each model was categorized using rule-in and rule-out criteria (three categorized analyses). To avoid overfitting, the diagnostic accuracies were evaluated based on 5-fold cross-validation.

Results: PDFF + cT1 (PcT) had the highest diagnostic performance for severe activity (hepatic inflammation plus ballooning grade ≥ 3) and for NAS ≥ 4 (active MASH). Areas under receiver operating characteristic curves (AUROCs) of M-PcT (0.832) for detecting at-risk MASH were significantly higher than those of Fibroscan-AST (FAST) (0.744, p = 0.017), MRI-AST (MAST) (0.710, p = 0.002), and MPcT (0.695, p < 0.001) in three categorized analysis. Following the rule-in criteria, positive predictive values of M-PcT (84.5%) were higher than those of FAST (73.5%), MAST (70.0%), and MPcT (66.7%). Following the rule-out criteria, negative predictive values of M-PcT (88.7%) were higher than those of FAST (84.0%), MAST (73.9%), and MPcT (84.9%).

Conclusions: The two-step strategy, M-PcT (paired score), showed the reliability of rule-in/-out for at-risk MASH, with better predictive performance compared with FAST and MAST (combined score).

Clinical trial registration: This study is registered with ClinicalTrials.gov (number, UMIN000012757).

Key points: Question There is no mpMRI-based method for detecting as-risk MASH (NAFLD activity score ≥ 4 with fibrosis stage ≥ 2) like FAST and MAST scores. Findings MRE-based LSMs followed by PDFF with cT1 (M-PcT) were more useful in detecting at-risk MASH than the combined score (FAST and MAST). Clinical relevance By combining MRE and PDFF with cT1, it becomes possible to evaluate the pathology of MASH without the need for a liver biopsy, assisting in prognosis prediction and decision-making for treatment options.

Keywords: At-risk MASH; FAST; M-PcT; MAST; MPcT.

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Conflict of interest statement

Compliance with ethical standards. Guarantor: The scientific guarantor of this publication is Atsushi Nakajima. Conflict of interest: A.A. is an employee of Perspectum Ltd. KIYSKNSNNKMIYHTKYOHT. The remaining authors report no competing interests to disclose. Statistics and biometry: One of the authors (Y.S.) has significant statistical expertise. Informed consent: Written informed consent was obtained from all subjects (patients) in this study. Ethical approval: The protocol for this study was approved by the Ethics Review Board at Yokohama City University. Study subjects or cohorts overlap: This study cohort included some of the patients analysed in a previous report (World J Gastroenterol. 2021 Feb 21;27(7):609–623). Methodology: Prospective study/diagnostic study Performed at one institution

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