S2564 Closing the Gap: Identifying Previously Undiagnosed Metabolic Associated Steatotic Liver Disease From Radiologic Reports

Introduction: Metabolic associated steatotic liver disease (MASLD) represents accumulation of excess fat in the liver due to metabolic diseases which can lead to inflammation and eventually fibrosis and cirrhosis. However, despite being highly prevalent, this is also highly under-diagnosed. The purpose of this study was to identify previously undiagnosed patients with MASLD based on radiology reports. Methods: A retrospective electronic health record (EHR) based study was done at a large academic health center in the United States, with data reviewed from 2011-2023. Radiology reports from CT, MRI, ultrasound, and Vibration controlled transient elastography (VCTE) were searched for “steatosis”, “hepatosteatosis”, or “fatty infiltration” (henceforth referred as “radiographic fatty liver”). Adult patients with radiographic fatty liver findings were included. Minors, patients who opted out of research, and patients with known liver disease were excluded (e.g. viral hepatitis, hemochromatosis, primary biliary cholangitis, autoimmune hepatitis, secondary biliary cirrhosis, Wilson’s disease, alcohol use disorder, alcohol associated liver disease, cirrhosis, hepatocellular carcinoma, and liver transplant status). The following International Classification of Diseases, Ninth and Tenth Revision (ICD-9/10) codes were used: K76.0 (fatty liver, not elsewhere classified), 571.8 (other chronic nonalcoholic liver disease), and 75.81 (nonalcoholic steatohepatitis) to determine diagnosis of fatty liver in the chart. Patients who had no ICD code in the chart were also excluded. Results: Total of 133,574 patients had radiographic fatty liver in the chart but only 39,167 of them had a corresponding ICD code of fatty liver (29.3%). Conclusion: In this single center retrospective study, over 70% of patients with radiographic fatty liver did not have any corresponding ICD code in the chart. This is likely generalizable to other health centers across the United States and shows a large, missed opportunity for early intervention for treating MASLD. This study also shows a methodological pathway that can be used to identify previously undiagnosed MASLD patients via radiographic studies. These patients can be identified early and sent for further risk stratification based on well-established criteria (e.g. FIB4/VCTE) and sent for appropriate treatment modalities.