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Mouse Model of Metabolic Dysfunction-Associated Steatotic Liver Disease with Fibrosis
Published on: July 18, 2025
Screening for Fibrosis in Metabolic Dysfunction-Associated Steatotic Liver Disease: Evidence, Challenges, and the
Shin Mei Chan1, Cheng William Hong1, Lael Ceriani2
1Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, CA.
Insights
Metabolic dysfunction-associated steatotic liver disease (MASLD) affects 40% of the global population. Early detection and risk stratification using imaging are crucial for managing MASLD and preventing severe liver complications.
Area of Science:
- Hepatology
- Cardiology
- Radiology
Background:
- Metabolic dysfunction-associated steatotic liver disease (MASLD) impacts 40% of the global population.
- While often linked to cardiovascular issues, MASLD typically progresses to severe liver disease only after fibrosis develops.
- MASLD with significant fibrosis indicates a poorer prognosis and necessitates specialized care.
Purpose of the Study:
- To review current and best practices for screening adults to detect and stratify MASLD.
- To highlight the critical and evolving role of imaging in managing MASLD.
- To guide the identification of patients with MASLD who may benefit from pharmacotherapy or intensive monitoring.
Main Methods:
- Selective screening of high-risk populations, including those with diabetes and cardiometabolic risk factors.
- Initial assessment using blood-based tests.
- Second-line evaluation with noninvasive imaging to confirm significant or advanced fibrosis and stratify risk.
Main Results:
- MASLD with clinically significant fibrosis (stage ≤2) is linked to worse outcomes.
- Noncirrhotic significant fibrosis (stage 2-3) may allow for pharmacotherapy to prevent cirrhosis.
- Advanced fibrosis (stage ≤3) and cirrhosis (stage 4) require intensive monitoring and specific management strategies.
Conclusions:
- Professional societies recommend screening for MASLD with significant or advanced fibrosis in high-risk individuals.
- Imaging plays a pivotal role in the detection, risk stratification, and management of MASLD.
- Effective screening and stratification are essential public health strategies for addressing the growing burden of MASLD.
Abstract:
Metabolic dysfunction-associated steatotic liver disease (MASLD) affects 40% of the world's population. Despite an association with increased cardiovascular morbidity, MASLD usually does not lead to liver-related adverse outcomes until fibrosis develops. MASLD with clinically significant fibrosis (histologic fibrosis stage ≤2) is associated with poorer prognosis and helps guide management, including specialty care referral. Among adults with MASLD, those with noncirrhotic clinically significant fibrosis (stage 2 or 3) may be eligible for pharmacotherapy to prevent progression to cirrhosis; those with advanced fibrosis (stage ≤3) usually require intensive monitoring; and those with cirrhosis (stage 4) may require additional supportive therapy and surveillance for gastroesophageal varices or primary liver cancer. Professional societies now recommend selective screening of high-risk patients to detect MASLD with clinically significant or advanced fibrosis. While guideline details vary, the screening population generally includes those with diabetes, other cardiometabolic factors, or incidentally detected steatosis. Screening begins with blood-based tests; second-line assessment, possibly including noninvasive imaging, seeks to verify MASLD with clinically significant or advanced fibrosis, stratify risk, and inform management. This Special Series Review describes current and best practices for screening adults to detect and stratify MASLD, focusing on imaging's critical and evolving role in addressing this public health challenge.
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