Rajarshi Banerjee, MD, PhD, MSc, is an internist with Oxford University Hospitals with a specific interest in hepatology and is also the founder of Perspectum Diagnostics Ltd. 

Rajarshi Banerjee, MD, PhD, MSc

Multiparametric MRI’s Cost-Effectiveness for MASH, with Rajarshi Banerjee, MD, PhD

New research suggests multiparametric magnetic resonance imaging (mpMRI) with LiverMultiScan is a viable tool for identifying and managing patients with 

metabolic dysfunction-associated steatotic liver disease (MASLD

), offering a cost-effective alternative to liver biopsy and other noninvasive tests.

“Multiparametric MRI is a very great technology for tissue characterization, and since the diagnosis of MASH, metabolic associated steatohepatitis, is a tissue characterization diagnosis… the technology and the disease meet like hand and glove,” Rajarshi Banerjee, MD, PhD, CEO of Perspectum, told 

The RADIcAL-1 trial enrolled more than 800 patients from Germany, the Netherlands, Portugal, and the UK to test the cost-effectiveness and resource use associated with Perspectum’s LiverMultiScan, a commercially available, FDA-cleared software medical device intended for diagnosis, monitoring, and clinical management of patients with liver diseases. The non-invasive, non-contrast technology assesses liver disease activity, fat, and iron using existing MRI infrastructure.

In RADIcAL-1, investigators assessed whether mpMRI with LiverMultiScan plus standard of care (SoC) was more cost-effective than SoC alone for MASLD risk stratification. Results showed mpMRI improved diagnosis rates, reduced the need for specialist consultations, and avoided unnecessary liver biopsies.

Although patients in the SoC arm of the trial had significantly more specialist appointments with healthcare professionals and for patient assessments than those in the imaging arm (

= .015), the imaging arm had a significantly higher percentage of patients with a final diagnosis at the end of the trial compared with SoC (57% vs 48%; 

Additionally, using a QALY loss of 0.03 per patient per missed diagnosis, the use of mpMRI in the imaging arm was deemed to be cost-effective with an incremental cost-effectiveness ratio of €5067.77 ($5,530.28 USD) per 1.02 QALYs gained (€4968.40[$5,421.09 USD]/QALY gained).

“The fact that not only was this the most effective test, but it was cost-effective versus all the cheaper tests, was the real eye opener here. Many found it surprising, including some of the study authors,” Banerjee said. “That should help develop the key pillars to get this into guidelines in different countries.”

Banerjee concluded by saying that he believes patients with liver disease deserve better than what is currently being provided to them.

“We have ways to monitor and manage disease such that you can prevent heart attacks and prevent liver-related outcomes. Whilst you're always in a position where you could do more research, don't let the welfare of the patient be sacrificed for that extra paper or that extra outcome measure,” he said. “I think that's really important to highlight because there is a strong body of evidence that LiverMultiScan should be used clinically, and that's been demonstrated in several settings.”

Editors’ note: Banerjee has relevant disclosures with Perspectum.

Brooks A.Multiparametric MRI Cost-Effective for Noninvasively Identifying, Managing MASLD. 

. March 18, 2025. Accessed March 19, 2025. 

https://www.hcplive.com/view/multiparametric-mri-cost-effective-noninvasively-identifying-managing-masld

Perspectum. LiverMultiScan Clinical Primer. Accessed March 19, 2025. 

https://www.perspectum.com/clinical-solutions/livermultiscan-healthcare-professionals

Videos

Banerjee explains the need for noninvasive tests for MASH and reviews promising findings from the RADIcAL-1 trial of LiverMultiScan versus standard of care.

Arab and Banerjee discuss how new therapies change discussions around screening, management of MASH

How New Therapies Change Discussions Around Screening, Management of MASH

In the final part of our 5-part video series, Arab and Banerjee discuss how an approval for MASH, such as resmetirom might shift discussions about the need for screening from reactive to proactive. The pair conclude the overall discussion by highlighting the importance of implementing screening strategies for asymptomatic patients with suspected liver disease. Banerjee outlines that establishing outpatient community diagnostic centers, where patients undergo blood tests and scans to determine their eligibility for treatment, will be critical in the UK and elsewhere. He highlights the role of primary care providers in prescribing medications based on recommendations from specialist clinics.

Arab also emphasized the importance of preventive medicine and the need to allocate resources effectively to target high-risk populations. He discusses the triage process in Ontario, Canada, where patients are assessed based on their risk of advanced liver disease and referred for further testing accordingly. Later, the pair agree on the necessity of non-invasive assessments, such as transient elastography, to identify patients who may benefit from treatment.

Before concluding the conversation, Arab and Banerjee touch on the scalability of screening programs, with Banerjee mentioning the increasing accessibility of diagnostic tests like MRI and fibroscan. Both experts commented on the availability of these technologies and emphasize the importance of tailoring screening strategies to each health system's resources and population needs.

Editor’s Note: This conversation was recorded on March 14, 2024 prior to the FDA’s approval of resmetirom.

Arab has no relevant disclosures to report. Banerjee’s disclosures include Perspectum Ltd.

Articles

In the final installment in our 5-part video series, our pair of experts in hepatology touch upon how an approval for MASH would impact conversations around screening for asymptomatic patient populations. 

 How New Therapies Change Discussions Around Screening, Management of MASH

JP Arab, MD, and Rajarshi Banerjee, MD, PhD, MSc, discuss how the study population of MAESTRO-NASH compares to MASH population in real-world settings. 

Comparing MAESTRO-NASH to Real-World MASH Populations

In this portion of the discussion, Arab and Banerjee address how the population and inclusion criteria for MAESTRO-NASH compare to that of real-world populations with MASH, with a specific focus on fibrosis levels. To begin the discussion, Arab notes a substantial proportion of patients in the MAESTRO study had advanced fibrosis (F3 or higher), which may influence the perspectives of clinicians entering the field. Banerjee emphasizes that the distribution of fibrosis severity can vary depending on the clinical setting, with primary care offices likely seeing more patients with early-stage fibrosis (F1 or F2) and liver transplant centers dealing with more advanced cases.

Regarding treatment targets, Banerjee suggests focusing on patients with higher fibrosis scores (F2 or F3) as they are at greater risk of adverse outcomes and may derive the most benefit from treatment. Arab concurs with this sentiment, suggesting an approach targeting this population could help prevent disease progression and associated complications, such as cirrhosis.

When discussing thresholds for initiating treatment, Banerjee mentions the use of transient elastography (Fibroscan) to assess fibrosis levels. He suggests using thresholds such as less than 8 for non-significant fibrosis (F0-F1) and greater than 12 for significant fibrosis (F2-F3), with patients falling between 8 and 12 potentially deriving the greatest magnitude of benefit from treatment.

Editor’s Note: This conversation was recorded on March 14, 2024 prior to the FDA’s approval of resmetirom. 

In part 4 of our 5-part video series, Arab and Banerjee discuss how the study population of MAESTRO-NASH compares to MASH populations in real-world settings. 

Real-World MASH Populations Compared to MAESTRO-NASH

JP Arab, MD, and Rajarshi Banerjee, MD, PhD, discuss MAESTRO-NASH and how it informs use of resmetirom in NASH. 

Understanding Resmetirom's Potential Based on MAESTRO-NASH

The discussion highlights how the advent of an approved therapy for MASH, formerly known as NASH, might impact the management of the disease. Recorded prior to the approval of resmetirom, the discussion centers around how the MAESTRO-NASH trial might inform use of the agent in real-world settings.

The trial results, recently published in the New England Journal of Medicine, indicate significant improvements in key clinical outcomes compared to a placebo, with around 25% of patients experiencing improvement and even higher rates with higher doses of the medication. The conversation also touches on the practical aspects of prescribing and monitoring patients on the medication. Both Arab and Banerjee agree that when the drug becomes available, they would consider prescribing it, especially for high-risk MAFLD populations

Later, the pair discuss the importance of monitoring for both efficacy and side effects, including gastrointestinal symptoms and muscle-related issues. Monitoring liver enzymes, liver function tests, and non-invasive fibrosis assessments like transient elastography are recommended, with consideration for potential changes in cardiovascular outcomes over time. Additionally, Arab and Banerjee emphasize the need for long-term follow-up given the gradual nature of fibrosis improvement.

In part 3 of our 5-part discussion, Arab and Banerjee dive into the results of the pivotal MAESTRO-NASH trial and how it can inform use of resmetirom in real-world settings. 