Characteristics and Outcomes of Patients With Imaging-Defined MASLD and Histological Steatosis Grade S0.
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Liu Wen-Yue, Lian Li-You, Kim Seung Up, Cheuk-Fung Yip Terry, Petta Salvatore, Nakajima Atsushi, Tsochatzis Emmanuel, Shi Junping, Chan Wah-Kheong, Boursier Jérôme, Bugianesi Elisabetta, Yilmaz Yusuf, Hagström Hannes, Romero-Gomez Manuel, Alswat Khalid, Calleja José Luis, Takahashi Hirokazu, de Lédinghen Victor, Shalimar, Castéra Laurent, Sanyal Arun J, Boon-Bee Goh George, Newsome Philip N, Fan Jian-Gao, Lai Michelle, Aggarwal Sandeep, Kechagias Stergios, Hiasa Yoichi, Dayal Bheesham, Zhang Zhongtao, George Jacob, El-Kassas Mohamed, Chen Jinjun, You Hong, Abu Dayyeh Barham K, Sheng Huiping, Adams Leon A, Wang Jing, He Fangping, Liang Huiqing, Yang Yong-Feng, Chi Xiaoling, Zhong Bihui, Bi Yan, Mi Yuqiang, Zhu Yongfen, Bai Rixing, Zhang Jing, Wang Bingyuan, Song Jinghai, Deng Hong, Xie Qing, Bai Lang, Xin Yongning, Xie Wen, Li Jie, Fournier Céline, Liao Bing, Xu Hong-Hai, Li Yang-Yang, Zhang Huai, Feng Qin, Zoncapè Mirko, Wu Chutian, Lee Hye Won, Lai-Hung Wong Grace, Armandi Angelo, Shang Ying, Pennisi Grazia, Llop Elba, Yoneda Masato, de Saint-Loup Marc, Gallego-Durán Rocio, Fernández Paloma Carrillo, Asgharpour Amon, Kim-Jun Teh Kevin, Sau-Wai Chan Mandy, Lin Huapeng, Song Sherlot Juan, Al-Hamoudi Waleed K, Isoda Hiroshi, Miyake Teruki, Satapathy Sanjaya K, Li Mengyi, Sharma Keshni, Emadeldeen Mohammed, Zhou Ling, Tong Xiaofei, Bazerbachi Fateh, Fan Xiaotang, Xiao Huanming, Ye Junzhao, Xu Liang, Wang Xiaolin, Aldoheyan Tamadr Abdulrhman, Targher Giovanni, Byrne Christopher D, Wong Vincent Wai-Sun, Zheng Ming-Hua
Аннотация
METHODS: Steatosis 0 was defined as imaging-detected MASLD with a biopsy-defined steatosis grade S0. We used global cohorts to evaluate outcomes, histologic progression by paired biopsies, and possible causes. The cause analysis included MRI-proton density fat fraction (MRI-PDFF) for fat distribution, pathologist consistency testing, and comparison of serial biopsy sections.
RESULTS: In a follow-up cohort of 3,273 biopsy individuals from 16 centers, 123 (3.8%) exhibited steatosis 0. Of these, 29.3% of them had advanced fibrosis (burnt-out MASLD) and demonstrated a risk of liver-related events, whereas those without advanced fibrosis had no such events. In the paired-biopsy cohort of 1,865 patients, 74 (4.0%) individuals initially showed steatosis grade S0; among them, 93.2% retained no or mild steatosis on follow-up biopsy. MRI-PDFF assessments in 42 MASLD patients revealed heterogeneous hepatic fat distribution, with some segments showing steatosis grade S0 despite elevated average liver fat. Interpathologist variability and discrepancies across consecutive biopsy sections contributed to misclassification of steatosis grade.
DISCUSSION: Steatosis 0 represents a potential diagnostic gray zone in MASLD. It may be caused by burnt-out MASLD, uneven liver fat distribution, or variability in pathological assessment. Understanding the causes and implications of steatosis 0 is critical for diagnosis and management.