ArticleCureus2025
MRI-Derived Fat Fraction Is Superior to Ultrasonography in Predicting Subclinical Atherosclerosis in Metabolically Healthy Non-alcoholic Fatty Liver Disease.
Article in Cureus, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundSubclinical atherosclerosis in metabolic dysfunction-associated steatotic liver disease (MASLD) is well established. However, its presence in patients with metabolically healthy non-alcoholic fatty liver disease (MH-NAFLD) remains unclear.
aimTo determine the prevalence of subclinical atherosclerosis in patients with MH-NAFLD and to evaluate whether higher grades of hepatic steatosis are associated with increased carotid intima-media thickness (CIMT).
methodsIn this prospective observational study, adults with ultrasonography (USG)-confirmed hepatic steatosis and no components of metabolic syndrome were compared with age- and sex-matched healthy controls. Hepatic steatosis was quantified using MRI-proton density fat fraction (MRI-PDFF), and subclinical atherosclerosis was assessed via CIMT. A CIMT ≥ 0.84 mm was considered elevated. Associations were evaluated using Spearman's correlation and hierarchical linear regression.
resultsA total of 100 participants (median age 36.5 years, IQR 29.0-45.25) were enrolled: 50 with MH-NAFLD (28, 56% males) and 50 matched controls (31, 62% males). MRI-PDFF stratified MH-NAFLD patients as Grade 0 (8, 16%), Grade 1 (23, 46%), Grade 2 (11, 22%), and Grade 3 (8, 16%). Elevated CIMT was observed in 13 (26%) MH-NAFLD participants vs 1 (2%) control (p = 0.001). None of the patients with Grade 0 steatosis had elevated CIMT, whereas all with Grade 3 did. MRI-PDFF grading showed a strong correlation with CIMT (ρ = 0.80, p < 0.0001). In hierarchical regression, MRI-PDFF significantly improved CIMT prediction (ΔR² = 0.39, p < 0.001), while USG lost statistical significance.
conclusionMH-NAFLD is associated with increased CIMT. MRI-PDFF is a superior predictor of subclinical atherosclerosis compared to USG, highlighting its utility for vascular risk stratification.
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