Noninvasive Testing for Metabolic Dysfunction-Associated Steatohepatitis (MASH) and Fibrosis

Patients with metabolic dysfunction-associated steatohepatitis (MASH), particularly those with clinically significant fibrosis (≥F2), are at highest risk for adverse liver outcomes. This narrative review summarizes blood-based scores, imaging tools, and combined indices used to detect and risk stratify patients with MASH and fibrosis. We focus on cutoffs and dynamic trajectories that best capture patients at highest risk for adverse liver events and outline how these noninvasive tests can be integrated into simple stepwise pathways to guide referral and treatment and reduce reliance on liver biopsy.