Imaging Evaluation for Steatotic Liver Disease

Abstract

Metabolic dysfunction-associated steatotic liver disease (MASLD), previously known as nonalcoholic fatty liver disease, is the fastest-growing cause of chronic liver disease worldwide, affecting approximately 30% of the global population. Imaging is vital for detecting, quantifying, and monitoring hepatic steatosis-the defining abnormality of MASLD-and subsequent fibrosis-the key determinant of liver-related outcomes. This review summarizes the principles, clinical usage, efficacy, and advancements in various imaging modalities for the noninvasive assessment of hepatic steatosis and fibrosis, with an emphasis on ultrasound, CT, and MRI. Additionally, this review explores the evolving landscape of MASLD diagnostic approaches, including machine-learning techniques, opportunistic screening, standardized imaging guidelines, and therapies, emphasizing the pivotal role that radiologists can play in shaping these developments.

Keywords: CSE-MRI; Chemical-shift-encoded; MASLD; MR elastography; Metabolic dysfunction-associated steatotic liver disease; PDFF; Proton density fat fraction; Quantitative ultrasound.