What is NASH?
Non-Alcoholic Steatohepatitis (NASH) is the most severe form of Non-Alcoholic Fatty Liver Disease (NAFLD), a highly underdiagnosed cause of severe liver complications. NAFLD is estimated to affect nearly 80 million people in the US, but only 5% are aware they have liver disease.
Regular MRI exams can't assess liver fibrosis
MR Elastography exam mapping liver fibrosis
Diagnosis
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 can utilzie a combination of MRI biomarkers and blood tests.
Parameter
Liver Fat
Measured by:
MRI-PDFF
Liver Fibrosis
MR Elastography
MRI exam
Liver Inflammation
AST/FIB-4
Blood work
Together, these markers of disease activity can be very accurate for ruling-in "at-risk NASH" and assessing its severity - and most critically, the fibrosis stage. Fibrosis is measured by the MR Elastography (MRE), which was invented at Mayo Clinic. Severe liver fibrosis is the parameter of liver histology that is most associated to adverse liver outcomes (e.g., cirrhosis).
NASH Scoring
There are a number of new scoring systems to help diagnose "at-risk NASH" - namely those with NASH and ≥F2 fibrosis. You can use the calculator here to automatically calculate your patient's risk of NASH using two of these scoring systems: the MAST score and MEFIB score.
The MAST score uses MRE, MRI-PDFF and AST, and has been shown to have high accuracy in predicting adverse clinical outcomes in the next five years. The MEFIB score uses MRE and FIB-4 score to rule-in patients with NASH and ≥F2 fibrosis with a positive predictive value of ≥90%.
MRE is central to both scoring systems. Referred to as the Gold Standard for non-invasive fibrosis assessment, MRE is the only MRI exam that can accurately stage liver fibrosis - which numerous clinical guidelines recognize as essential for a personalized health care plan.
Results
F0
F1
F2
F3
F4
MR Elastography (kPa)
MRI-PDFF (%)
FIB-4
AST (U/L)
(must use FIB-4)
How to interpret MAST/MEFIB
low-risk of NASH with advanced fibrosis
indeterminate (if applicable)
high-risk of NASH with advanced fibrosis
Required Fields
MAST: MRE + PDFF + AST
MEFIB: MRE + FIB-4
How to Use This Calculator
Depending on score, the MAST score can be used to reliably predict (with high 80-low 90% accuracy) which patients are most likely to experience a liver-related event in the next five years.
The MEFIB score can reliably predict (90%+ accuracy) which patients currently are most likely to at-NASH with ≥F2 fibrosis, and who may be candidates for pharmacological treatment.
If Your Patient is at-Risk for NASH
If you suspect your patient has NASH with fibrosis, there are treatment options.
Most cases of NASH can be treated with life style changes (including diet and exercise regimens) and/or prescription medicines.
www.coulditbeNASH.org is supported by Resoundant. Other NASH scoring systems may be used by clinicians. Calculations should be re-checked and should not be used alone to guide patient care, nor should they substitute for clinical judgment.
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This webpage encludes 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.