{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T11:18:00Z","timestamp":1788866280903,"version":"build-2803163510"},"reference-count":42,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2023,10,30]],"date-time":"2023-10-30T00:00:00Z","timestamp":1698624000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100005564","name":"Gilead Sciences","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100005564","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004587","name":"Instituto de Salud Carlos III","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004587","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Liver International"],"published-print":{"date-parts":[[2024,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background and Aims<\/jats:title><jats:p>Diagnosis of metabolic dysfunction\u2010associated steatohepatitis (MASH) requires histology. In this study, a magnetic resonance imaging (MRI) score was developed and validated to identify MASH in patients with metabolic dysfunction\u2010associated steatotic liver disease (MASLD). Secondarily, a screening strategy for MASH diagnosis was investigated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This prospective multicentre study included 317 patients with biopsy\u2010proven MASLD and contemporaneous MRI. The discovery cohort (Spain, Portugal) included 194 patients. NAFLD activity score (NAS) and fibrosis were assessed with the NASH\u2010CRN histologic system. MASH was defined by the presence of steatosis, lobular inflammation, and ballooning, with NAS \u22654 with or without fibrosis. An MRI\u2010based composite biomarker of Proton Density Fat Fraction and waist circumference (MR\u2013MASH score) was developed. Findings were afterwards validated in an independent cohort (United States, Spain) with different MRI protocols.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In the derivation cohort, 51% (<jats:italic>n<\/jats:italic>\u2009=\u200999) had MASH. The MR\u2013MASH score identified MASH with an AUC\u2009=\u2009.88 (95% CI .83\u2013.93) and strongly correlated with NAS (<jats:italic>r<\/jats:italic>\u2009=\u2009.69). The MRI score lower cut\u2010off corresponded to 88% sensitivity with 86% NPV, while the upper cut\u2010off corresponded to 92% specificity with 87% PPV. MR\u2013MASH was validated with an AUC\u2009=\u2009.86 (95% CI .77\u2013.92), 91% sensitivity (lower cut\u2010off) and 87% specificity (upper cut\u2010off). A two\u2010step screening strategy with sequential MR\u2013MASH examination performed in patients with indeterminate\u2010high FIB\u20104 or transient elastography showed an 83\u201384% PPV to identify MASH. The AUC of MR\u2013MASH was significantly higher than that of the FAST score (<jats:italic>p<\/jats:italic>\u2009&lt;\u2009.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The MR\u2013MASH score has clinical utility in the identification and management of patients with MASH at risk of progression.<\/jats:p><\/jats:sec>","DOI":"10.1111\/liv.15766","type":"journal-article","created":{"date-parts":[[2023,10,31]],"date-time":"2023-10-31T05:59:23Z","timestamp":1698731963000},"page":"202-213","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Development and validation of an image biomarker to identify metabolic dysfunction associated steatohepatitis: <scp>MR\u2013MASH<\/scp> score"],"prefix":"10.1111","volume":"44","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4266-6076","authenticated-orcid":false,"given":"David","family":"Marti\u2010Aguado","sequence":"first","affiliation":[{"name":"Digestive Disease Department Clinic University Hospital, INCLIVA Health Research Institute  Valencia Spain"},{"name":"Biomedical Imaging Research Group (GIBI2<sup>30<\/sup>) La Fe Health Research Institute, and Imaging La Fe node at Distributed Network for Biomedical Imaging (ReDIB) Unique Scientific and Technical Infrastructures (ICTS)  Valencia Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joud","family":"Arnouk","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Hepatology and Nutrition, Center for Liver Diseases Pittsburgh Liver Research Center, University of Pittsburgh Medical Center  Pittsburgh Pennsylvania 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