{
  "abstract": "There is a need for robust evaluations of noninvasive biomarkers for metabolic dysfunction-associated steatotic liver disease. This prospective multicenter study assessed the diagnostic accuracy of imaging (including liver stiffness measurement (LSM) using magnetic resonance elastography (MRE) and FibroScan (vibration-controlled transient elastography (VCTE)), serum biomarkers (including NIS2+) and composite scores (including Agile 3+ and Agile 4) for centrally read steatohepatitis and fibrosis. For cirrhosis, several biomarkers exceeded the minimum acceptable performance criterion (MAC), including MRE (area under the receiver operating curve (AUC) 0.91; P < 0.01), VCTE-LSM (AUC 0.87; P < 0.01), Agile 3+ (AUC 0.89; P < 0.01) and Agile 4 (AUC 0.88; P < 0.01). Among 357 participants, fibrosis stages F0-F4 were present in 12%, 16%, 25%, 32% and 15%, respectively. NIS2+ had the highest diagnostic accuracy among serum biomarkers for metabolic dysfunction-associated steatohepatitis (MASH; AUC 0.83) and at-risk MASH (MASH with at least stage 2 fibrosis; AUC 0.82), although neither significantly exceeded the MAC (P = 0.15 and P = 0.19). Among imaging biomarkers, MRE showed the highest performance for MASH (AUC 0.71) and at-risk MASH (AUC 0.75), but these remained below the MAC. For fibrosis staging, performance was stronger: MRE met the MAC for advanced fibrosis (AUC 0.91; P < 0.01), as did Agile 3+ (AUC 0.84; P = 0.03). For cirrhosis, several biomarkers exceeded the MAC, including MRE (AUC 0.91; P < 0.01), VCTE-LSM (AUC 0.87; P < 0.01), Agile 3+ (AUC 0.89; P < 0.01) and Agile 4 (AUC 0.88; P < 0.01). Serum biomarkers tended to outperform imaging for identifying at-risk MASH, whereas elastography and composite scores showed excellent accuracy for staging advanced fibrosis and cirrhosis.",
  "abstract_shown": true,
  "affiliations": [
    "Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK. michael.pavlides@cardiov.ox.ac.uk",
    "Oxford NIHR Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust and the University of Oxford, Oxford, UK. michael.pavlides@cardiov.ox.ac.uk",
    "Translational Gastroenterology and Liver Unit, University of Oxford, Oxford, UK. michael.pavlides@cardiov.ox.ac.uk",
    "Department of Epidemiology and Data Science, Amsterdam Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands",
    "Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach, Germany",
    "Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK",
    "Newcastle NIHR Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK",
    "Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK",
    "Antaros Medical AB, Mölndal, Sweden",
    "Perspectum Ltd., Oxford, UK",
    "Resoundant Inc., Rochester, MN, USA",
    "Hepatic and Digestive Diseases Networking Biomedical Research Centre (CIBERehd), Grupo de Física Interdisciplinar, Universidad de Sevilla, Sevilla, Spain",
    "Instituto de Biomedicina de Sevilla, IBiS/Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, Spain",
    "Nordic Bioscience, Biomarkers & Research, Herlev, Denmark",
    "Oxford NIHR Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust and the University of Oxford, Oxford, UK",
    "Translational Gastroenterology and Liver Unit, University of Oxford, Oxford, UK",
    "Liver Unit, Department of Medicine, Cambridge NIHR Biomedical Research Centre, Cambridge University NHS Foundation Trust, Cambridge, UK",
    "NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK",
    "Nottingham Digestive Diseases Centre, Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK",
    "Digestive Diseases Unit, Hospital Universitario Virgen del Rocío, Sevilla, Spain",
    "Hepatic and Digestive Diseases Networking Biomedical Research Centre (CIBERehd), Instituto de Biomedicina de Sevilla, Universidad de Sevilla, Sevilla, Spain",
    "Department of Gastroenterology, Clinic University Hospital, Medical School, University of Valladolid, CIBERINFEC, Valladolid, Spain",
    "Liver Unit, Vall d'Hebron Institut de Recerca, Vall d'Hebron Barcelona Hospital, Universitat Autònoma de Barcelona, Centros de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain",
    "HIFIH Laboratory, SFR ICAT 4208, Angers University, Angers, France",
    "Hepato-Gastroenterology and Digestive Oncology Department, Angers University Hospital, Angers, France",
    "Section of Gastroenterology and Hepatology, PROMISE, Palermo, Italy",
    "Department of Internal Medicine II, Saarland University Medical Center, Homburg, Germany",
    "Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden",
    "Department for Visceral Medicine and Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland",
    "Department of Biomedical Research, University of Bern, Bern, Switzerland",
    "Department of Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland",
    "Minerva Foundation Institute for Medical Research, Helsinki, Finland",
    "Novartis Institutes for BioMedical Research, Basel, Switzerland",
    "Digital Sciences and Translational Imaging, Pfizer Inc., Cambridge, MA, USA",
    "Resolution Therapeutics, London, UK",
    "Department of Radiology, Mayo Clinic, Rochester, MN, USA",
    "Department of Pathology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece",
    "Genfit S.A., Loos, France",
    "Echosens, Paris, France",
    "Assistance-Publique Hôpitaux de Paris, INSERM UMRS 1138 CRC, Paris, France"
  ],
  "article_type": null,
  "arxiv": null,
  "author_total": 100,
  "authors": [
    {
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        0,
        1,
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      "name": "Michael Pavlides",
      "orcid": "0000-0001-9882-8874"
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    {
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        3
      ],
      "name": "Yasaman Vali",
      "orcid": "0000-0001-7002-118X"
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    {
      "affs": [
        4,
        5
      ],
      "name": "Ferenc Emil Mózes",
      "orcid": "0000-0002-1361-4349"
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        7
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      "name": "Kristy Wonders",
      "orcid": "0000-0001-6407-9721"
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      "name": "Salma Akhtar"
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      "name": "Paul D. Hockings",
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      "name": "Elizabeth Shumbayawonda",
      "orcid": "0000-0003-0351-2063"
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      "name": "Kay Pepin"
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      "name": "Isabel Fernández-Lizaranzu",
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      "name": "Diana Julie Leeming",
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      "name": "Jeremy F. Cobbold"
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      "name": "Michael E.D. Allison"
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      "name": "Guruprasad Padur Aithal",
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      "name": "Manuel Romero‐Gómez",
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      "name": "Rocio Aller"
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      "name": "Juan Manuel Pericàs",
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      "name": "Jérôme Boursier",
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      "name": "Salvatore Petta",
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      "name": "Jörn Markus Schattenberg",
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      "name": "Mattias Ekstedt",
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      "name": "Annalisa Berzigotti",
      "orcid": "0000-0003-4562-9016"
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      "name": "Hannele Yki‐Järvinen",
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      "name": "Miljen Martić",
      "orcid": "0000-0002-0166-5421"
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      "name": "Theresa A. Tuthill",
      "orcid": "0000-0003-0170-3974"
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      "name": "Clifford A. Brass"
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        10
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      "name": "Michael J. Kalutkiewicz"
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        9
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      "name": "Rajarshi Banerjee",
      "orcid": "0000-0003-2022-5218"
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        35
      ],
      "name": "Richard L. Ehman",
      "orcid": "0000-0001-7041-5074"
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        8
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      "name": "Moritz J. Schneider",
      "orcid": "0009-0002-4097-2317"
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        36,
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      "name": "DINA G. TINIAKOS",
      "orcid": "0000-0003-4657-7780"
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        13
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      "name": "Morten Karsdal"
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      "name": "Jérémy Magnanensi",
      "orcid": "0009-0005-2886-8105"
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        38
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      "name": "Céline Fournier",
      "orcid": "0000-0003-1934-4965"
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      "affs": [
        39
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      "name": "Vlad Ratziu",
      "orcid": "0000-0002-6865-3791"
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    {
      "name": "Carla Yunis",
      "orcid": "0009-0002-4280-3429"
    },
    {
      "name": "Elisabetta Bugianesi",
      "orcid": "0000-0002-0502-4381"
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      "affs": [
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      "name": "Stephen A. Harrison",
      "orcid": "0000-0001-8285-2204"
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    {
      "name": "Quentin M. Anstee",
      "orcid": "0000-0002-9518-0088"
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        6,
        7
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      "name": "Ann Daly"
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        7
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      "name": "Fiona Oakley",
      "orcid": "0000-0001-8692-1836"
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        7
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      "name": "Simon Cockell",
      "orcid": "0000-0002-6831-9806"
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        36,
        7
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      "name": "DINA G. TINIAKOS",
      "orcid": "0000-0003-4657-7780"
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      "affs": [
        7
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      "name": "Pierre Bédossa",
      "orcid": "0000-0002-8487-7322"
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      "name": "Heather Jane Cordell",
      "orcid": "0000-0002-1879-5572"
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      "name": "Christopher Paul Day",
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        7
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      "name": "Kristy Wonders",
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      "name": "Olivier Govaere",
      "orcid": "0000-0002-4426-6930"
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      "name": "Paolo Missier B",
      "orcid": "0000-0002-0978-2446"
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        7
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      "name": "Matthew McTeer",
      "orcid": "0009-0006-2889-030X"
    },
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      "name": "Luke Vale"
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    {
      "name": "Yemi Oliboyede"
    },
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      "name": "Matthew Breckons",
      "orcid": "0000-0003-3057-6767"
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      "name": "Patrick M. Bossuyt",
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      "name": "Yasaman Vali",
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      "name": "Jenny Lee",
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      "name": "Yaïr I. Z. Acherman",
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      "name": "Arnold van de Laar"
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      "name": "Adriaan Georgius Holleboom",
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  ],
  "bibtex": "https://research.draconitic.com/paper/b6djmwhb9bfsz.bib",
  "cited_by": 8,
  "doi": "10.1038/s41591-026-04496-2",
  "fulltext_url": null,
  "id": "b6djmwhb9bfsz",
  "issns": [
    "1078-8956",
    "1744-7933",
    "1546-170X"
  ],
  "landing_url": "https://hal.science/hal-05840940v1",
  "language": "en",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "journal",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
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      "2713|Liver Disease Diagnosis and Treatment"
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  "pdf_url": "https://www.nature.com/articles/s41591-026-04496-2.pdf",
  "pmcid": "PMC13472969",
  "pmid": "42498741",
  "published": "2026-07-24",
  "publisher": "Nature Publishing Group",
  "ris": "https://research.draconitic.com/paper/b6djmwhb9bfsz.ris",
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      "url": "https://hal.science/hal-05840940v1"
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  "subjects": [
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      "field": "medicine",
      "origin": "openalex:2713|Liver Disease Diagnosis and Treatment",
      "subfield": "epidemiology-public-health"
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  ],
  "title": "Prospective validation of imaging and serum diagnostic biomarkers of steatohepatitis and fibrosis in MASLD: the LITMUS Imaging Study",
  "title_text": "Prospective validation of imaging and serum diagnostic biomarkers of steatohepatitis and fibrosis in MASLD: the LITMUS Imaging Study",
  "type": "peer-reviewed",
  "updated_at": "2026-11-02T13:20:46Z",
  "url": "https://research.draconitic.com/paper/b6djmwhb9bfsz",
  "venue": "Nature Medicine",
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}