OBJECTIVES: To evaluate the concordance between vibration-controlled transient elastography (VCTE) and magnetic resonance elastography (MRE) for staging liver fibrosis and assessing hypothetical eligibility for resmetirom treatment in a cohort of patients with metabolic dysfunction-associated steatotic liver disease (MASLD). A secondary objective was to assess the performance of VCTE for liver fat quantification.
MATERIALS AND METHODS: This retrospective study included 103 patients (61 males; mean age 54.7 years) with suspected MASLD who underwent VCTE and MRI/MRE. The following parameters were extracted: liver stiffness (LS) from both techniques, controlled attenuation parameter (CAP) from VCTE, and MRI-proton density fat fraction (PDFF). Agreement and fibrosis stage distributions were assessed using Cohen's Kappa and McNemar's tests. ROC analysis assessed the performance of CAP against MRI-PDFF (considered the reference for steatosis).
RESULTS: A significant difference was observed in assigned fibrosis stage distributions between VCTE and MRE across all combinations (F0-F1 vs F2-F4, F0-F2 vs F3-F4, F0-F3 vs F4, all p < 0.001) with fair to moderate agreement between modalities (Cohen's Kappa values 0.305-0.554). VCTE assigned a higher fibrosis stage in 42 patients (40.7%). Thirty-three vs eighteen patients were classified as F2-F3 (qualified for resmetirom treatment) with VCTE vs MRE (Cohen's Kappa 0.215), which was associated with estimated cost savings of $707,701/year with MRE. VCTE-CAP achieved AUCs of 0.547, 0.754, and 0.813 for diagnosing mild, moderate, and severe steatosis, respectively.
CONCLUSION: VCTE and MRE have fair to moderate agreement for fibrosis staging, with VCTE tending to assign a higher fibrosis stage compared to MRE. VCTE-CAP reliably detects only severe steatosis.
KEY POINTS: Question What is the agreement between VCTE and MRE in staging fibrosis in MASLD and identifying patients with F2-F3 disease? Findings Limited concordance was found between VCTE and MRE for staging liver fibrosis and identifying F2-F3 disease; VCTE tended to assign higher fibrosis stages compared to MRE. Clinical relevance MRE could represent the modality of choice for selecting patients with metabolic dysfunction-associated steatohepatitis for resmetirom therapy as it potentially offers high cost-savings compared to VCTE.
