Post AASLD Reflection
- November 23, 2022
Reflections on AASLD 2022
Welcome back to the Education Hub. For those who attended this year’s annual conference of the American Association for the Study of Liver Disease (AASLD), we hope you had a productive meeting. I enjoyed the opportunity to meet face-to-face with many of our collaborators and leading voices in the field. One of the highlights for me was watching Dr. Naim Alkhouri and Prof. Stephen Harrison present to a full house on “Bringing clarity to NAFLD/NASH with LiverMultiScan”.
During the session, Dr. Alkhouri explained that the corrected T1 (cT1) biomarker, which measures liver disease activity, has an important role in the diagnostic pathway for patients with NAFLD. This role was also recognized in the recent American Association of Clinical Endocrinology Clinical Practice Guideline for the Diagnosis and Management of Nonalcoholic Fatty Liver Disease in Primary Care and Endocrinology Clinical Settings, co-sponsored by AASLD. Dr. Alkhouri highlighted that in his opinion, cT1 has a high negative predictive value for ruling out at-risk NASH, and that a “cT1 > 875 ms increases specificity and positive predictive value, which is important in sub-specialty clinics when you need to be more confident.” He further elaborated that cT1 can be used to measure a decline in liver health, with the evidence indicating there is “a stepwise increase in cT1 as fibrosis progresses.”
He said, “I used to require my residents to do 30 biopsies before they could graduate. Now I only biopsy for a diagnostic dilemma. Noninvasive tests such as LiverMultiScan do the job.”
-Dr. Carlos Duncker
Photograph taken at the LiverMultiScan Product Theater, AASLD 2022, showing Dr Naim Alhouri at the podium (left) and Professor Stephen Harrison (right).
Highlighted Article
Finally, I’d like to share the clinical pathway analysis presented by Dr. Alkhouri during The Liver Meeting (Alkhouri, N., et al. (2022). Hepatology, 76(S1), S803–S804). In this pathway analysis, the inclusion of cT1 for patients with indeterminate, failed, or discordant results from traditional fibrosis tests (serum-based tests and liver stiffness test [vibration-controlled transient elastography, VCTE]):
- Improved the classification of patients with at-risk NASH (F ≥ 2) by 63%.
- Provided an 80% increase in patients with advanced fibrosis (F ≥ 3) being correctly classified as having high risk disease.
- Reduced the number of patients being referred to a specialist by 63% (see Figure 1 below).
Please view the full poster with details of the study and the results.
Figure 1: Diagnostic pathway flow chart combining cT1 with traditional fibrosis tests. cT1 thresholds were < 800 ms to rule out NASH and ≥ 875 ms to rule in at-risk NASH. Thresholds for traditional fibrosis tests were: (1) Liver stiffness measurement (LSM) < 6 kPa to rule out advanced fibrosis and (2) LSM + serum-based markers to rule in advanced fibrosis (LSM ≥ 14 kPa + FIB-4 ≥ 3.25 or LSM ≥ 20 kPa + platelets < 150 109/L or LSM ≥ 25 ). Pathway image modified from Alkhouri, N., et al. (2022). Hepatology, 76(S1), S803–S804.
Disclosures
- LiverMultiScan cT1 and PDFF are manufactured by Perspectum.
- Some uses of LiverMultiScan cT1 and PDFF described above (such as the cut-off values) have not been approved or cleared by the FDA.
- Dr Carlos Duncker is a Perspectum employee.
- Dr. Naim Alkhouri and Professor Stephen Harrison are paid consultants for Perspectum.