Imaging-based fibrosis assessment and risk stratification in MASLD
Shunqin Jin1, Tao Zhou2, Dachuan Jin3
1Department of Nuclear Medicine, The First Medical Center, Chinese PLA General Hospital, Beijing, China.
Frontiers in Medicine
|July 28, 2026
Summary
Non-invasive imaging tests like ultrasound elastography and MRI are crucial for assessing liver fibrosis in metabolic dysfunction-associated steatotic liver disease (MASLD). These methods aid in risk stratification and monitoring treatment effectiveness, overcoming biopsy limitations.
Area of Science:
- Hepatology
- Medical Imaging
- Non-invasive Diagnostics
Background:
- Metabolic dysfunction-associated steatotic liver disease (MASLD) is a leading cause of chronic liver disease globally.
- Liver fibrosis stage significantly impacts patient outcomes and mortality.
- Liver biopsy is limited for widespread use due to invasiveness and sampling issues.
Purpose of the Study:
- To review imaging-based fibrosis assessment in MASLD.
- To discuss diagnostic performance, limitations, and prognostic value of various imaging tools.
- To propose a framework for clinical decision-making in MASLD fibrosis staging.
Main Methods:
- Review of ultrasound elastography, magnetic resonance elastography, and multiparametric MRI.
- Analysis of diagnostic performance, technical limitations, and prognostic value.
- Integration of imaging with serum-based non-invasive tests.
Main Results:
- Ultrasound elastography is a practical first-line imaging test for MASLD.
- Magnetic resonance elastography provides high diagnostic confidence, especially for indeterminate cases.
- Combined approaches using serum markers and imaging enhance risk stratification.
Conclusions:
- Imaging plays a vital role beyond diagnosis in MASLD fibrosis assessment.
- A stepwise clinical decision-making pathway integrating imaging biomarkers is proposed.
- Multimodal approaches are increasingly favored over single-modality assessments for MASLD fibrosis.
