Imaging-Based Modalities for Identifying At Risk MASH. A Diagnostic Test Meta-Analysis.

Noninvasive, accurate diagnostic tools are critical for identifying patients at risk (metabolic activity score ≥4, F ≥ 2).

非侵入性、准确的诊断工具对于识别有风险的患者（代谢活动评分≥4，F≥2）至关重要。

This meta-analysisevaluates the diagnostic performance of imaging-based technologies for ruling-in (TRI) and ruling-out (TRO) at risk MASH.

本荟萃分析评估了基于影像技术的诊断性能，用于确诊（TRI）和排除（TRO）有风险的MASH。

Methods

A systematic search of Medline and Embase (inception to December 20, 2024) identified studies reporting on MRI-based diagnostic techniques for at risk MASH.

通过系统检索Medline和Embase（从创刊到2024年12月20日），确定了报告基于MRI的诊断技术用于有风险的MASH的研究。

Eligible studies were independently screened, with 20 studies meeting inclusion criteria.

符合条件的研究被独立筛选，有20项研究符合纳入标准。

Sensitivity, specificity, and diagnostic odds ratios (DORs) were calculated using bivariate meta-analysis, applying prespecified TRO and TRI thresholds to each technique.

使用双变量荟萃分析计算了敏感性、特异性和诊断比值比（DORs），对每种技术应用了预设的TRO和TRI阈值。

Results

Twenty studies involving 9,480 participants were included.

纳入了涉及9,480名参与者的研究共20项。

FibroScan-aspartate aminotransferase (FAST) demonstrated highest TRO sensitivity (0.871) with moderate specificity (0.567) and TRI specificity (0.900) with reduced sensitivity (0.441).

FibroScan-天冬氨酸氨基转移酶（FAST）显示出最高的TRO敏感性（0.871），特异性适中（0.567），而TRI特异性较高（0.900），但敏感性降低（0.441）。

Magnetic resonance elastography plus fibrosis-4 achieved high TRO sensitivity (0.812) but lower specificity (0.606); TRI specificity was 0.872, sensitivity was 0.500.

磁共振弹性成像联合纤维化-4指数实现了高TRO敏感性（0.812），但特异性较低（0.606）；TRI的特异性为0.872，敏感性为0.500。

MRI-aspartate aminotransferase exhibited intermediate performance, while cT1 thresholds showed variable diagnostic accuracy.

MRI-天冬氨酸氨基转移酶表现出中等性能，而cT1阈值显示出可变的诊断准确性。

A sensitivity analysis of head-to-head studies shows superior performance in FAST compared with other diagnostic methods.

对头对头研究的敏感性分析显示，与其他诊断方法相比，FAST表现出更优越的性能。

Discussion

FAST with its accessibility and robust diagnostic performance may be well-suited for large-scale application.

FAST因其可访问性和强大的诊断性能，可能非常适合大规模应用。

MRI-based techniques are effective noninvasive options for diagnosing at risk MASH in metabolic dysfunction-associated steatotic liver disease and may provide strong alternatives.

基于MRI的技术是诊断代谢功能障碍相关脂肪肝病中高风险MASH的有效无创选择，并可能提供强有力的替代方案。

Rather than challenging existing perspectives, this study provides a reflective overview of current evidence on imaging-based modalities for at risk MASH.

这项研究并不是挑战现有的观点，而是对当前关于高风险MASH的基于影像学的模态的证据进行了反思性的概述。