Part 3: CAR Metabolic Dysfunction-Associated Steatotic Liver Disease Working Group Recommendations for Ultrasound Shear Wave Elastography and MR Elastography Program Implementation, Funding, and Quality Assurance

The Canadian Association of Radiologists (CAR) metabolic dysfunction-associated steatotic liver disease (MASLD) Working Group (WG) is a multidisciplinary working group composed of radiologists, hepatologists, and family physicians. In this 3-part series, we provide Delphi consensus-based guidance on clinical and imaging findings for patients with known or suspected MASLD (formerly termed nonalcoholic fatty liver disease or NAFLD). Part 1 focuses on the detection and grading of hepatic steatosis on imaging; Part 2 on risk stratification of patients with MASLD, including a patient pathway that applies blood-based and imaging-based investigations; and Part 3 on the implementation of practice recommendations for quality assurance using shear wave elastography (SWE) and magnetic resonance elastography (MRE) for disease staging. In the third part of these guidelines, the WG provides 18 recommendations for standardized implementation, remuneration, and quality assurance for SWE and MRE programs. Structured reporting templates for standardized SWE and MRE are provided. Introductory training presentations for technologists and radiologists are also provided. The goal of these guidelines is to enable standardized image-based screening and risk stratification of patients with MASLD across Canada.