Academic radiology · 2026
Non-invasive Tests for the Prediction of Liver-related Events in Patients with MASLD: A Systematic Review and Meta-analysis.
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Wang Xinkai, Dong Xue, Qian Luodan, Yang Zhenghan, Yang Dawei, Niu Yantao
Аннотация
RATIONALE AND OBJECTIVES: While guidelines recommend tests like the FIB-4 index and liver stiffness measurements (LSM) to identify high-risk Metabolic dysfunction-associated steatotic liver disease (MASLD) patients, their actual accuracy in predicting liver-related events (LREs) remains unclear. Here, we systematically evaluate their prognostic performance to better inform clinical decisions.
MATERIALS AND METHODS: We systematically searched Cochrane Library, Embase, PubMed and Web of Science (up to January 7, 2026), to identify studies utilizing non-invasive tests (NITs) for predicting incident LREs and reporting their prognostic performance. Subgroup analyses and meta-regression were performed based on dataset characteristics to explore potential sources of heterogeneity. All pooled analyses were conducted using a random-effects model.
RESULTS: This meta-analysis included a total of 30 studies involving 67,533 patients with MASLD. The results demonstrated that for predicting incident LREs, the pooled C-index for Vibration-Controlled Transient Elastography (VCTE), the FIB-4 index, and Magnetic Resonance Elastography (MRE) were 0.83 (95% CI: 0.79-0.87), 0.82 (95% CI: 0.78-0.85), and 0.78 (95% CI: 0.64-0.91), respectively. In the evaluation of secondary outcomes, the pooled C-index of VCTE for predicting hepatocellular carcinoma (HCC) was 0.78 (95% CI: 0.70-0.86). Regarding mortality risk prediction, the pooled C-index for VCTE and the FIB-4 index were 0.83 (95% CI: 0.76-0.89) and 0.75 (95% CI: 0.66-0.84), respectively.
CONCLUSION: The FIB-4 index and LSM measured by VCTE exhibit robust prognostic discrimination for LREs in MASLD. Existing evidence supports the FIB-4 index and VCTE as routine non-invasive prognostic tests. Furthermore, the prognostic performance of MRE requires additional validation in future research.
MATERIALS AND METHODS: We systematically searched Cochrane Library, Embase, PubMed and Web of Science (up to January 7, 2026), to identify studies utilizing non-invasive tests (NITs) for predicting incident LREs and reporting their prognostic performance. Subgroup analyses and meta-regression were performed based on dataset characteristics to explore potential sources of heterogeneity. All pooled analyses were conducted using a random-effects model.
RESULTS: This meta-analysis included a total of 30 studies involving 67,533 patients with MASLD. The results demonstrated that for predicting incident LREs, the pooled C-index for Vibration-Controlled Transient Elastography (VCTE), the FIB-4 index, and Magnetic Resonance Elastography (MRE) were 0.83 (95% CI: 0.79-0.87), 0.82 (95% CI: 0.78-0.85), and 0.78 (95% CI: 0.64-0.91), respectively. In the evaluation of secondary outcomes, the pooled C-index of VCTE for predicting hepatocellular carcinoma (HCC) was 0.78 (95% CI: 0.70-0.86). Regarding mortality risk prediction, the pooled C-index for VCTE and the FIB-4 index were 0.83 (95% CI: 0.76-0.89) and 0.75 (95% CI: 0.66-0.84), respectively.
CONCLUSION: The FIB-4 index and LSM measured by VCTE exhibit robust prognostic discrimination for LREs in MASLD. Existing evidence supports the FIB-4 index and VCTE as routine non-invasive prognostic tests. Furthermore, the prognostic performance of MRE requires additional validation in future research.