Fibrosis
Scoring
Liver disease is characterized by the accumulation of liver fat (steatosis), liver inflammation and, ultimately, liver fibrosis. While measures of each of these parameters are helpful, clinicians should pay particular attention to the degree of fibrosis, as it is the only histological feature of liver disease that is linked with adverse liver events. The most accurate noninvasive exam for assessing liver fibrosis is by MR Elastography (MRE), which was invented at Mayo Clinic. Clinicians can use the calculator here to help assess the progression of liver fibrosis based on their liver stiffness via MRE.
F0
F1
F2
F3
F4
Correlation with fibrosis stage
NASH
Scoring
NASH is a complex disease that requires doctors to know about three critical components of liver health: Liver Fat, Liver Fibrosis and Liver Inflammation. To get a good idea of each of these without liver biopsy, physicians rely on a combination of MRI biomarkers and blood tests.
Liver Fat
Liver Fibrosis
Liver Inflammation
MRI-PDFF
MR Elastography
AST/ALT/FIB-4
MRI exam
Blood work
There have been a number of scoring systems created to help diagnose NASH and you can use the calculator here to automatically calculate your patient's risk of NASH using these scoring systems. These scoring systems have been developed to Rule-in or Rule-out "at-risk NASH" - which is defined as NASH plus fibrosis ≥F2. Clinicians can then use the MRE result (in kPa) to determine the level of liver fibrosis.
Rule-in "at-risk NASH"
What does the MAST scale denote?
low-risk of NASH with fibrosis (>F2) (with 90% sensitivity)
indeterminate
high-risk of NASH with fibrosis ≥F2 (with 90% specificity)
For more information on these scoring systems, visit:
Noureddin, M., Truong, E., Gornbein, J. A., Saouaf, R., Guindi, M., Todo, T., Noureddin, N., Yang, J. D., Harrison, S. A., & Alkhouri, N. (2021). MRI-based (MAST) score accurately identifies patients with NASH and significant fibrosis. Journal of hepatology, S0168-8278(21)02184-X. Advance online publication. https://doi.org/10.1016/j.jhep.2021.11.012
Jung, J., Loomba, R. R., Imajo, K., Madamba, E., Gandhi, S., Bettencourt, R., Singh, S., Hernandez, C., Valasek, M. A., Behling, C., Richards, L., Fowler, K., Sirlin, C. B., Nakajima, A., & Loomba, R. (2021). MRE combined with FIB-4 (MEFIB) index in detection of candidates for pharmacological treatment of NASH-related fibrosis. Gut, 70(10), 1946–1953. https://doi.org/10.1136/gutjnl-2020-322976
The software is Clinical Decision Support Software and is exempt from regulation by the FDA under 21 U.S.C. 360j(o). By using this software, the user acknowledges and agrees that he or she is a health care professional experienced in diagnosing liver disease. The software only supports or provides recommendations to a health care professional, who must not rely primarily on any such recommendations to make a clinical diagnosis or treatment decision regarding an individual patient and who may independently review the basis for such recommendations. The user is solely responsible for any final decision regarding the condition of any individual patient. The user agrees to indemnify and hold harmless Resoundant from any costs, expenses, damages, or other liabilities resulting from any claims relating to use of the software.
These scores were developed based on pools of cohorts and are published in peer-reviewed literature. They are presented as educational services intended for licensed healthcare professionals. While these scores are about specific medical and health issues, they are not substitutes for or replacements of personalized medical advice and are not intended to be used as the sole basis for making individualized medical or health-related decisions.