# Overall Diagnostic Efficiency of a Noninvasive Diagnostic Strategy Aimed at Early Detection of Advanced Liver Fibrosis in Metabolic Dysfunction-Associated Steatotic Liver Disease Cases

## TL;DR

This study compares noninvasive strategies for detecting advanced liver fibrosis in patients with metabolic dysfunction-associated steatotic liver disease, finding that combining blood tests with imaging methods improves diagnostic accuracy.

## Contribution

The study introduces a simulation-based evaluation of noninvasive diagnostic strategies for liver fibrosis detection, identifying optimal test combinations.

## Key findings

- Combining Fib-4 with MRE or SWE achieves high diagnostic accuracy (0.90-0.93) for advanced liver fibrosis detection.
- Adding serum fibrosis markers as an intermediate step further improves diagnostic accuracy and reduces false positives.
- Two-step and three-step diagnostic strategies show comparable efficiency in early detection of advanced liver fibrosis.

## Abstract

Introduction

Noninvasive methods for assessing liver fibrosis are increasingly important for early detection of advanced liver fibrosis (ALF), particularly in patients with metabolic dysfunction-associated steatotic liver disease (MASLD). This study aimed to evaluate the overall diagnostic ability and efficiency (ODAE) of noninvasive diagnostic strategies incorporating imaging tests and to identify optimal test combinations for early ALF detection.

Methods

We conducted a simulation of 10,000 MASLD patients, assuming an ALF prevalence of 15%. Two diagnostic strategies were evaluated. Strategy one (two-step): patients positive on the Fibrosis-4 (Fib-4) index (cutoff ≥1.3) underwent magnetic resonance elastography (MRE), vibration-controlled transient elastography (VCTE), or shear wave elastography (SWE). Strategy two (three-step): Fib-4-positive patients underwent additional serum fibrosis marker testing - enhanced liver fibrosis score, Mac-2-binding protein glycosylation isomer, or type IV collagen 7S - followed by imaging if positive. Diagnostic performance, including net sensitivity, specificity, predictive values, and accuracy, was estimated using decision tree analysis based on published parameters.

Results

Fib-4 identified 5,742 positive cases. Strategy one achieved high accuracy (0.90-0.93); combining Fib-4 with MRE or SWE as a secondary test demonstrated good and comparable ODAE. Strategy two further improved positive predictive value and reduced false positives compared with strategy one.

Conclusions

Combining Fib-4 with MRE or SWE provides comparable and efficient diagnostic performance for early detection of ALF. Adding serum fibrosis markers as an intermediate step may further reduce false positives and enhance diagnostic accuracy.