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Imaging of MASLD: clinical standards and novel methods
Marc Jonuscheit1,2, Vera B Schrauwen-Hinderling3,4
1Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
Diabetologia
|July 16, 2026
Summary
Non-invasive imaging techniques are crucial for diagnosing and staging metabolic dysfunction-associated steatotic liver disease (MASLD). This review explores current and emerging imaging methods, highlighting their potential to replace liver biopsy for accurate patient assessment.
Area of Science:
- Hepatology and Gastroenterology
- Medical Imaging and Radiology
- Biomedical Engineering
Background:
- Metabolic dysfunction-associated steatotic liver disease (MASLD) diagnosis and staging rely heavily on non-invasive imaging.
- Liver biopsy is the current gold standard for assessing fibrosis and inflammation severity in MASLD.
- Advancements in imaging offer potential non-invasive alternatives to liver biopsy for MASLD staging.
Purpose of the Study:
- To review established and emerging imaging techniques for MASLD diagnosis and staging.
- To analyze the measurement principles, diagnostic performance, and limitations of various imaging modalities.
- To discuss the future potential of multiparametric and multimodal imaging strategies in MASLD management.
Main Methods:
- Review of conventional and advanced imaging techniques including ultrasound, CT, MRI, and nuclear imaging.
- Analysis of quantitative ultrasound (e.g., controlled attenuation parameter) and elastography (transient and magnetic resonance elastography).
- Evaluation of MRI techniques (e.g., proton density fat fraction, MRE) and nuclear imaging (PET, SPECT) for fibrosis and inflammation assessment.
Main Results:
- Conventional ultrasound is a widely used first-line screening tool but lacks sensitivity for mild steatosis.
- Quantitative ultrasound and transient elastography improve steatosis and fibrosis assessment, respectively.
- MRI-based methods (e.g., MRI-PDFF, MRE) offer high accuracy for quantifying liver fat and stiffness, considered reference standards, while nuclear imaging provides functional and molecular insights.
Conclusions:
- Imaging modalities are evolving as non-invasive tools for MASLD diagnosis and staging, with MRI and advanced ultrasound showing significant promise.
- Future MASLD management will likely integrate multiparametric and multimodal imaging biomarkers with clinical data for precise risk stratification and treatment monitoring.
- Continued research into novel imaging tracers and techniques is essential for advancing precision medicine approaches in MASLD.
