SIMULTANEOUS screening for advanced fibrosis and metabolic dysfunction-associated steatotic liver disease (MASLD) using vibration-controlled transient elastography (VCTE) alongside routine retina scanning was evaluated in a large cross-sectional study conducted in Stockholm, Sweden. The study aimed to explore the feasibility and effectiveness of implementing this dual-screening approach for individuals with Type 2 diabetes, a group at increased risk of liver disease.
From November 2020–June 2023, 1,301 individuals with Type 2 diabetes were invited to undergo VCTE during their routine retina scanning appointments. Exclusions included individuals with Type 1 diabetes, known liver disease, high alcohol consumption, or those who did not meet other eligibility criteria. A total of 1,005 participants (77.2%) accepted the offer, with 973 (96.8%) completing the procedure successfully. Liver stiffness and controlled attenuation parameter (CAP) values were recorded to detect liver fibrosis and MASLD, respectively. Elevated liver stiffness was defined as a value of at least 8.0 kPa, while possible advanced fibrosis was indicated by measurements above 12.0 kPa.
The results revealed that 504 participants (51.8%) had CAP values of 280 dB/m or higher, suggesting the presence of MASLD. Among those with reliable liver stiffness measurements, 154 (15.8%) had elevated values of at least 8.0 kPa, and 49 (5.0%) had values above 12.0 kPa. However, secondary evaluation with a liver specialist showed that 45.2% of participants with initial elevated readings had liver stiffness values below 8.0 kPa upon reassessment, indicating a high rate of false positives. Final measurements confirmed that 7.4% of participants had liver stiffness values of at least 8.0 kPa, and 2.9% had values above 12.0 kPa.
This study demonstrates that combining VCTE with retina scanning has a high acceptance rate and offers a practical strategy for identifying individuals with potential liver fibrosis. However, the notable rate of false-positive findings underscores the need for secondary evaluations to confirm initial results and ensure accurate diagnoses.
Katie Wright, EMJ
Reference
Lindfors A et al. Screening for advanced liver fibrosis due to metabolic dysfunction-associated steatotic liver disease alongside retina scanning in people with type 2 diabetes: a cross-sectional study. Lancet Gastroenterol Hepatol. 2024; DOI:10.1016/S2468-1253(24)00313-3.
