Is the Enhanced Liver Fibrosis (ELF) test superior to the FIB-4 test in the diagnosis of MASLD?

In terms of diagnostic accuracy for advanced fibrosis in MASLD, ELF is superior to FIB-4; however, here are the caveats to consider:

FIB-4 is a simple and readily available test that is best used to rule out advanced fibrosis (high negative predictive value), and ELF is best used to rule in advanced...

I do find the ELF to be superior to FIB4 clinically for the following reasons: the FIB4 is generally less accurate in DM, which is a significant risk factor for developing advanced fibrosis. Also, since age is in the FIB4, it impacts the score, which has led to a cut of 2.0 in patients over 65 to se...

These two tests have different utilities, FIB 4 for screening and ELF for Diagnostic purposes.