Major International Studies Identify Accurate Non-Invasive Tests for Liver Disease

Two major international studies have delivered comprehensive evidence on which non-invasive tests can accurately diagnose and measure the severity of metabolic dysfunction-associated steatotic liver disease, commonly known as MASLD, and its advanced form, MASH. Published in The Lancet and Nature Medicine, the research forms part of the LITMUS programme, which represents the largest international effort to evaluate diagnostic tools for liver conditions.

Evaluating Diagnostic Tools Without Biopsy

The main LITMUS study, featured in The Lancet, assessed blood tests and ultrasound-based liver stiffness measurements across more than 1,500 patients. Simultaneously, the companion LITMUS Imaging Study, published in Nature Medicine, examined advanced magnetic resonance imaging and elastography techniques in over 350 patients. Led by Newcastle University and involving 53 international academic and industry partners, the programme aimed to reduce reliance on invasive liver biopsies.

Professor Quentin Anstee, joint senior author of both studies and the LITMUS consortium coordinator at Newcastle University, noted that the research provides a complete picture of which diagnostic tests function effectively and how they can be combined into implementable healthcare pathways. For advanced liver scarring and cirrhosis, the researchers found tools precise enough for clinical confidence, though detecting active liver inflammation remains more challenging.

Key Findings and Recommended Pathways

The evaluations highlighted several specific biomarkers and imaging technologies:

• For advanced fibrosis and cirrhosis, the SOMAScan proteomic panel, magnetic resonance elastography, and FibroScan-based elastography tools such as the Agile 3+ score showed the highest diagnostic accuracy.
• The enhanced liver fibrosis and ADAPT blood tests also exceeded predefined performance thresholds for detecting cirrhosis.
• For identifying at-risk MASH, only the SOMAScan panel met the predefined accuracy threshold.
• A simple gamma-GT blood test outperformed the commonly used FIB-4 score as a first-line assessment tool.

Researchers suggest these findings support a simplified diagnostic pathway for routine care. An initial gamma-GT screening could be followed by ELF or FibroScan tests for patients requiring further evaluation, while advanced imaging would be reserved for specialist care.