Imaging in MASLD

INTRODUCTION: Metabolic dysfunction-associated steatotic liver disease (MASLD) is now the leading cause of chronic liver disease (CLD) globally, with increasing prevalence and risk of progression to cirrhosis, hepatocellular carcinoma, and liver-related mortality. Early detection and accurate staging are essential to guide interventions as new therapies emerge. AREAS COVERED: This review discusses imaging-based evaluation of MASLD, emphasizing its role in assessing steatosis, fibrosis, and complications of CLD. A literature search of PubMed and Scopus identified peer-reviewed publications from 2000 to the present, including large clinical trials, expert reviews, and major hepatology and imaging guidelines. Key modalities evaluated include ultrasound, computed tomography, and magnetic resonance imaging. Advanced quantitative techniques, such as transient elastography, shear wave elastography, MR elastography, and MRI proton density fat fraction, are summarized. Their role in longitudinal monitoring and prediction of liver-related outcomes is discussed. Advances in ultrasound and emerging imaging biomarkers, including sarcopenia and visceral adiposity, are also briefly discussed. EXPERT OPINION: Imaging is central to precision hepatology in MASLD, enabling comprehensive, noninvasive assessment and integration with clinical data for risk stratification. The integration of clinical data, imaging findings, and elastography will further enhance individualized care and treatment monitoring.