Current Evidence on MR Elastography in Metabolic Dysfunction-Associated Steatohepatitis: A Scoping Review

Metabolic dysfunction-associated steatohepatitis (MASH) is a progressive liver disease associated with an increased risk of liver fibrosis, liver cirrhosis, and the development of hepatocellular carcinoma. Magnetic resonance elastography (MRE) has been established for non-invasively grading hepatic fibrosis and is increasingly used for assessing inflammation in research studies. The first pharmaceutical treatment of MASH -Resmetirom - was approved in the United States in March 2024 and received approval in Europe in August 2025. This circumstance will increase the demand for clinical and research MRE examinations. Therefore, this scoping review aims to provide an overview of the current research on the use of MRE in MASH for assessing fibrosis and inflammation.

A structured literature search was carried out within the MEDLINE and Embase + Embase Classic databases. A total of 11 studies within the last five years were included based on predefined criteria, such as prospective study design, histopathological validation as reference standard or comparisons with other non-invasive procedures.

The included studies encompassed diverse populations, methods, and outcome criteria. MRE demonstrated excellent diagnostic performance for liver fibrosis (AUC up to 0.97), outperforming many other non-invasive fibrosis tests. Additionally, preliminary studies suggest good performance for hepatic inflammation (AUC up to 0.83). Multiparametric approaches that combine MRE with other quantitative MRI-based methods, such as proton density fat fraction (PDFF) and corrected T1 (cT1), could further improve diagnostic performance in MASH.

These findings show that MRE is a reliable tool for non-invasively assessing hepatic fibrosis in MASH and shows promise to assess inflammation in the future.

· MRE shows excellent accuracy for fibrosis and good accuracy for inflammation in MASH.. · Multiparametric MRI improves diagnostic accuracy for steatosis, fibrosis, and inflammation.. · Further research needed to establish MRE as biopsy alternative for MASH..

· Widmann FP, Häseli SP, Schattenfroh J et al. Current Evidence on MR Elastography in Metabolic Dysfunction-Associated Steatohepatitis: A Scoping Review. Rofo 2024; DOI 10.1055/a-2807-9946.