Article Impact Level: HIGH Data Quality: STRONG Summary of The Lancet Gastroenterology & Hepatology. https://doi.org/10.1016/S2468-1253(24)00313-3 Dr. Andrea Lindfors et al.
Points
- The study found that 77.2% of eligible participants accepted vibration-controlled transient elastography (VCTE) screening for MASLD, with 96.8% obtaining complete measurements, demonstrating feasibility for integration with routine retina scanning.
- Among participants, 51.8% had controlled attenuation parameter (CAP) values indicative of MASLD, and 15.8% had elevated liver stiffness (≥8.0 kPa), while 5.0% showed values suggestive of advanced fibrosis (>12.0 kPa).
- Secondary assessments by liver specialists revealed a high rate of false positives in initial VCTE screenings, with 45.2% of individuals reassessed showing liver stiffness values below 8.0 kPa.
- After secondary evaluation, 7.4% of participants had confirmed elevated liver stiffness (≥8.0 kPa), and 2.9% had advanced fibrosis (>12.0 kPa).
- Integrating VCTE with routine diabetes care shows promise for MASLD detection but requires additional specialist evaluation to improve diagnostic accuracy and reduce false positives.
Summary
This cross-sectional study aimed to assess the feasibility of implementing vibration-controlled transient elastography (VCTE) for screening metabolic dysfunction-associated steatotic liver disease (MASLD) in people with type 2 diabetes, alongside routine retina scanning. The study in Stockholm, Sweden, included 1,301 eligible participants for VCTE screening and 1,005 (77.2%) accepted. The primary outcome was the acceptance rate of VCTE screening, and secondary outcomes included the prevalence of elevated liver stiffness (≥8.0 kPa), the presence of MASLD (controlled attenuation parameter [CAP] ≥280 dB/m), and the accuracy of the initial VCTE measurements.
The results revealed that 973 participants (96.8%) had complete measurements, with 504 (51.8%) showing CAP values indicative of MASLD. Regarding liver stiffness, 154 (15.8%) had values of at least 8.0 kPa, suggestive of fibrosis, and 49 (5.0%) had values over 12.0 kPa, indicating possible advanced fibrosis. However, upon secondary reassessment by a liver specialist, 56 (45.2%) of 124 individuals had liver stiffness measurements below 8.0 kPa, suggesting a high rate of false positives in the initial VCTE screening. In the final analysis, 74 (7.4%) of 1,005 participants had elevated liver stiffness (≥8.0 kPa), and 29 (2.9%) had values greater than 12.0 kPa.
This study demonstrates that integrating VCTE screening with routine retina scanning for people with type 2 diabetes is highly acceptable and could be an efficient strategy for detecting MASLD-related liver fibrosis. However, the high proportion of false positives indicates that further evaluation with liver specialists is crucial to confirm elevated liver stiffness measurements.
Link to the article: https://www.thelancet.com/journals/langas/article/PIIS2468-1253(24)00313-3/abstract
References Lindfors, A., Strandberg, R., & Hagström, H. (2024). Screening for advanced liver fibrosis due to metabolic dysfunction-associated steatotic liver disease alongside retina scanning in people with type 2 diabetes: A cross-sectional study. The Lancet Gastroenterology & Hepatology. https://doi.org/10.1016/S2468-1253(24)00313-3
