Metabolic dysfunction-associated steatotic liver disease (MASLD) occurs when fat builds up in the liver. It is increasingly common, affecting around 25-30% of the adult population worldwide. In some cases, MASLD progresses to a more serious condition called metabolic dysfunction-associated steatohepatitis (MASH), in which fat accumulation is accompanied by inflammation, formation of fibrosis, and increased risk of developing cirrhosis or hepatocellular carcinoma (HCC).
Early identification is key, yet the challenge lies in identifying the cases of MASLD that are likely to progress to MASH. Currently this requires taking a liver biopsy, which is invasive, resource-intensive and carries both a risk of complications to the patient and of sampling bias, as it may not be representative of the whole liver. This has created an unmet need for non-invasive alternatives; biomarkers that can reduce reliance on biopsy and help to identify and stage fibrosis in MASLD and MASH.
Developing, validating and assessing these biomarkers was the goal of the Liver Investigation: Testing Marker Utility for Steatohepatitis (LITMUS) consortium. The LITMUS Imaging Study prospectively validated and assessed the performance of imaging and serum biomarkers as well as composite scores. It showed that liver stiffness measured using magnetic resonance elastography (MRE) performed best for both advanced fibrosis and cirrhosis, highlighting the important role of advanced imaging biomarkers in the assessment of liver disease.
Vibration-controlled transient elastography (VCTE; FibroScan) and composite scores including liver stiffness measurements (Agile 3+ and Agile 4) also reached the minimum acceptable performance criteria. This may raise the question; why then should you use MRE instead of VCTE for measuring liver stiffness in a clinical trial?
The key advantages of MRE are its superior accuracy and reproducibility, which becomes increasingly important in clinical trials with limited number of participants or shorter timeframes. Another benefit is that it analyzes the whole liver, whereas VCTE samples only a small, localized area. VCTE, on the other hand, is less resource-intensive and more widely available, making it well suited for use in clinical practice.
We are proud to have contributed to the LITMUS Consortium and the LITMUS Imaging Study. Antaros Medical’s contributions were led by Paul Hockings, Senior Scientific Advisor and Moritz Schneider, Senior Director MR Imaging. You can read more about the LITMUS Imaging Study in the publication: https://www.nature.com/articles/s41591-026-04496-2 or in the main study publication: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(26)01145-1/abstract