Concordance of vibration-controlled transient elastography and magnetic resonance elastography for fibrosis staging in patients with metabolic dysfunction-associated steatotic liver disease

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.