mpMRI markers of liver disease are associated with lower health-related quality of life in MASHLiver imaging markers linked to lower quality of life

This multinational real-world randomized controlled trial evaluated the relationship between multiparametric MRI (mpMRI) markers and health-related quality of life (HRQoL) in a cohort of 802 patients with suspected metabolic dysfunction-associated steatotic liver disease (MASLD) and metabolic dysfunction-associated steatohepatitis (MASH). The study was conducted across multiple sites in Germany, the Netherlands, Portugal, and the United Kingdom. The primary objective was to determine if liver disease severity, as indicated by mpMRI markers such as cT1 and proton density fat fraction (PDFF), correlated with patient-reported outcomes.

The study utilized mpMRI markers (cT1 and PDFF) as the primary indicators of liver disease. The study population consisted of patients with suspected MASLD or MASH. While the specific protocol for the standard of care was not detailed, the study design allowed for the comparison of HRQoL between the MASLD and MASH subgroups. The follow-up period for the study was 12 months.

The primary outcome was HRQoL as measured by the EQ-5D instrument. The results indicated that patients with MASH experienced lower HRQoL compared to those with MASLD. Furthermore, patients with high-risk MASH complaints reported up to 12% more complaints in all EQ-5D dimensions compared to all other patients. Regarding secondary outcomes, the EQ-VAS and mpMRI markers (cT1, PDFF) were also analyzed. A significant correlation was found between the cT1 marker and mental health; the odds of reporting anxiety or depression were 29% higher associated with increasing cT1. Additionally, the EQ-5D utility score showed a 0.023-point decrease for every 80ms increase in cT1 (p = 0.039).

Safety and tolerability data were not reported for this study. No specific rates for adverse events, serious adverse events, or study discontinuations were provided in the source data.

These results provide evidence that liver disease severity, specifically MASH, is associated with a measurable decline in patient quality of life. While previous studies in this area have established the link between liver fibrosis and clinical outcomes, this study specifically highlights the utility of mpMRI markers as indicators of patient experience. The association between cT1 and mental health symptoms suggests that imaging markers may reflect the systemic impact of the disease.

Several methodological limitations were noted. Response rates at the 12-month follow-up point varied significantly across the different study sites, ranging from 22% to 81%. These variations were attributed to the impact of COVID-19 on patient participation. Because the study is a real-world trial, the findings represent associations rather than direct causal links between imaging markers and patient outcomes. For clinical practice, these findings suggest that mpMRI-defined MASH is associated with worse HRQoL independent of key metabolic comorbidities. Clinicians may find these results useful for disease stratification, using imaging biomarkers to identify patients who may require more intensive support for symptoms related to anxiety or depression. However, the wide variation in follow-up response rates across sites may affect the generalizability of the longitudinal data. Questions remain regarding the specific clinical interventions that could mitigate the decline in HRQoL associated with rising cT1 values.