Imaging-based fibrosis assessment and risk stratification in MASLD

Area of Science:

• Hepatology
• Medical Imaging
• Non-invasive Diagnostics

Background:

• Metabolic dysfunction-associated steatotic liver disease (MASLD) is a growing global health concern and a primary driver of chronic liver disease.
• Liver fibrosis staging is critical for predicting patient outcomes and mortality, but liver biopsy presents significant limitations for widespread clinical use.

Purpose of the Study:

• To review and synthesize the current state of imaging-based fibrosis assessment in MASLD.
• To evaluate the diagnostic performance, limitations, and prognostic value of various imaging modalities.
• To propose a framework for integrating imaging biomarkers into clinical decision-making for MASLD risk stratification.

Main Methods:

• Review of current literature on imaging techniques for MASLD fibrosis assessment.
• Emphasis on ultrasound elastography, magnetic resonance elastography, and multiparametric MRI.
• Discussion of emerging imaging tools and their integration with serum-based non-invasive tests.

Main Results:

• Ultrasound elastography is a scalable, first-line imaging test for MASLD fibrosis.
• Magnetic resonance elastography provides high diagnostic confidence, especially for indeterminate or discordant cases.
• Combined approaches using serum markers, elastography, and quantitative MRI are increasingly adopted for comprehensive risk assessment.

Conclusions:

• Imaging plays a vital role beyond diagnosis in managing MASLD, enabling risk stratification and treatment monitoring.
• A multimodal approach, integrating various imaging techniques and serum markers, offers a more robust strategy for patient management.
• The proposed framework guides the stepwise clinical decision-making process for MASLD patients based on imaging biomarkers.