Imaging Biomarkers in Metabolic Dysfunction Associated Steatotic Liver Disease

Abstract Purpose of Review Metabolic Dysfunction Associated Steatotic Liver Disease (MASLD) is the most common chronic liver disease in developed countries, affecting up to one third of adults. While the majority of individuals experience a benign course, a significant subset develop progressive liver disease and complications. This review aims to evaluate the role of non-invasive magnetic resonance (MR) biomarkers in assessing the key features of MASLD, namely steatosis, steatohepatitis, and fibrosis. Recent Findings Emerging evidence demonstrates that MR techniques, including magnetic resonance elastography (MRE), LiverMultiScan (LMS), and proton density fat fraction (PDFF), provide accurate and reproducible measures of fibrosis, steatosis, and disease activity. MRE shows the highest diagnostic accuracy for fibrosis staging, LMS has been validated in population studies, and PDFF is increasingly recognized as a predictor of treatment response. Summary MR-based biomarkers are promising non-invasive tools for diagnosis, risk stratification, and monitoring of MASLD. They may reduce reliance on liver biopsy in clinical practice and trials, though further validation of standardized thresholds and cost-effectiveness analyses are still needed.