Document Type

Conference Proceeding

Publication Date

10-2026

Publication Title

Hepatology

Abstract

Background: The MASH Resolution Index (MASHResInd) is a novel non-invasive score comprising baseline MRI-proton density fat fraction (MRI-PDFF), percentage change in MRI-PDFF, baseline alanine aminotransferase (ALT), change in ALT, and baseline aspartate aminotransferase (AST), developed to detect histological resolution of metabolic dysfunction-associated steatohepatitis (MASH) without worsening fibrosis. Despite its development in 2024, no synthesis of its diagnostic performance, comparative accuracy, and responsiveness to intervention exists. This systematic review and pooled analysis aimed to comprehensively evaluate the evidence for MASHResInd across pharmacological and non-pharmacological intervention settings. Methods: A systematic search of PubMed, Embase, and Cochrane databases was conducted through May 2026 using the terms "MASH Resolution Index," "MASHResInd," and related terms. Studies reporting diagnostic accuracy metrics or intervention-related changes in MASHResInd were included. Pooled sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated using a bivariate random-effects model. Comparative performance against the FibroScan-AST (FAST) score and individual non-invasive markers was assessed narratively. Results: Four studies comprising five independent cohorts (total n=583 patients with biopsy-confirmed MASH) were included. Across two diagnostic cohorts (derivation n=95; validation n=163), MASHResInd achieved pooled AUCs of 0.81–0.83. At the rule-out cut-point (≤−2.67), pooled NPV was 100% in the validation cohort, indicating high accuracy for excluding MASH resolution. At the rule-in cut-point (≥−0.67), pooled PPV was 29%, reflecting the low prevalence of MASH resolution across cohorts (18–22%). In a head-to-head comparison (n=160), MASHResInd significantly outperformed the FAST score (AUC 0.83 vs. 0.65; p=0.001), with superior sensitivity, NPV, and positive likelihood ratio. In a pooled analysis of three aerobic exercise RCTs (n=83), exercise training produced a significantly greater MASHResInd versus control (mean difference −0.66 units; p=0.046), with 36% of exercising participants meeting the MASH resolution threshold versus 19% of controls (OR 2.2), representing the first evidence of MASHResInd responsiveness to a non-pharmacological intervention. Conclusion: MASHResInd demonstrates consistent and superior diagnostic accuracy for MASH resolution compared to existing non-invasive tests across independent pharmacological and exercise intervention cohorts. Its high NPV at the rule-out threshold supports its utility in sparing patients from unnecessary liver biopsies. Further validation in ethnically diverse cohorts, recently approved therapies, and long-term outcomes studies is warranted.

Volume

84

Issue

S1

First Page

S1053

Comments

American Association for the Study of Liver Diseases (AASLD) Liver Meeting, November 5-9, 2026, Denver, CO

Last Page

S1053

DOI

10.1097/01.HEP.0001249256.48215.72

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