MASH: poorer quality of life in patients with elevated MRI markers

Comparing liver tests with patients’ lived experience

MASLD stands for metabolic dysfunction-associated steatotic liver disease. MASH is a progressive inflammatory form of the disease. The RADIcAL-1 study included 802 patients with suspected MASLD or MASH in Germany, the Netherlands, Portugal and the United Kingdom.

Participants completed the EQ-5D-5L quality-of-life questionnaire at baseline, then at 2, 6 and 12 months. A visual scale, the EQ-VAS, was also used to assess their overall health. The trial compared a group receiving imaging with a group receiving usual care.

For the analysis presented, the researchers specifically examined associations between quality of life and multiparametric MRI markers in the imaging group. MASH was defined using MRI criteria, rather than histological confirmation reported in the abstract.

An association that persists after adjustment

In the imaging group, patients classified as having MASH reported poorer quality of life across all questionnaire dimensions and on the overall health scale compared with patients classified as having MASLD. These differences persisted after adjustment for age, obesity, diabetes and hyperlipidaemia.

An increase of 80 milliseconds in corrected T1, or cT1, was associated with a decrease of 0.023 points in the EQ-5D utility score. This association was statistically significant, but the abstract does not establish whether this average difference represents a change that a patient would notice.

Patients classified as being at high risk of MASH also reported more difficulties across the quality-of-life dimensions studied. This suggests that imaging markers could help identify a greater disease burden, without replacing assessment of the patient’s lived experience.

What this study cannot establish

The randomised design of RADIcAL-1 does not turn the association between MRI markers and quality of life into evidence of causality. The abstract provides no result establishing that adding imaging improves quality of life compared with usual care.

Follow-up also has an important limitation: because of COVID-19, response rates at 12 months ranged from 22 to 81% across sites. These incomplete responses may influence comparisons over time. The findings also concern patients with suspected liver disease, not the general population.

What we can take away

This study links MRI-defined MASH to poorer quality of life. It supports the value of assessing patients’ lived experience alongside tests, but does not prove that imaging improves their health.