Abbreviated MRI as Frontline Screening for Metabolic Dysfunction-Associated Steatohepatitis (MASH) in Obese Patients with BMI > 32

Motivation: Metabolic dysfunction-associated steatohepatitis (MASH) represents a growing pandemic with obese patients at higher risk. However, obesity limits vibration-controlled transient elastography (VCTE) in frontline screening. Goal(s): We aimed to compare the effect of body mass index (BMI) on diagnostic performance of VCTE and abbreviated MRI. Approach: Patients (N=229) were enrolled into a prospective study with VCTE and a subset (N=59) underwent same-day abbreviated MRI. Results: Patients with BMI > 32 had a higher failure rate of VCTE at 33%, but MRI was diagnostic in all patients. Obese patients with BMI > 32 benefit from proceeding directly to MRI for hepatic evaluation. Impact: Obesity correlates with higher liver fibrosis in metabolic dysfunction-associated steatohepatitis (MASH), but also increases failure of vibration-controlled transient elastography (VCTE) in frontline screening. Abbreviated MRI should be considered a frontline screening modality in obese patients with BMI >32.