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Liver Health

NASH Clinical Tools

Intended for U.S. residents only

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Regular MRI exam that can't evaluate liver fibrosis

MR Elastography exam showing areas of fibrosis (in red)

NASH and Fibrosis 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.

Parameter

Liver Fat

MRI-PDFF

Measured by:

Liver Fibrosis

MR Elastography

MRI-icon-blue-green.png

MRI exam

Liver Inflammation

AST/ALT/FIB-4

Blood work

Together, these markers of disease activity can be very accurate for ruling-in "at-risk NASH" and assessing its severity. Clinicians should pay particular attention to the degree of fibrosis, as it is the most important clinical feature of liver disease. Liver fibrosis is measured by the MR Elastography (MRE), which was invented at Mayo Clinic.  Severe liver fibrosis is the one parameter of liver health that is linked to adverse liver outcomes (e.g., cirrhosis).  

NASH
Scoring

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.

Interested in using these scoring systems to help manage your patients? Find MRE near you at MRE:connect.

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

F1

F0

F2

F3

F4

Rule-in "at-risk NASH"

How to use this tool:

Enter values for MRE (kPa) and FIB-4

  • Look at the first scale to Rule-out or Rule-in "at-risk NASH"

  • Look at the second scale to assess fibrosis stage

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)

MAST Calculator

​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.

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