Recent Advances in Liver Computed Tomography and Magnetic Resonance Imaging Technologies

Recent technological innovations in computed tomography (CT) and magnetic resonance imaging (MRI) have significantly advanced the noninvasive evaluation of chronic liver diseases, including metabolic dysfunction-associated steatotic liver disease (MASLD), metabolic dysfunction-associated steatohepatitis (MASH), cirrhosis, and hepatocellular carcinoma (HCC). These imaging modalities have evolved from anatomical tools to integrated platforms for quantitative and functional assessments. This review provides a comprehensive overview of the principles, clinical applications, and diagnostic values of recent CT and MRI innovations. Developments such as dual-energy CT (DECT), low-tube-voltage CT, and photon-counting detector CT (PCD-CT) significantly enhance tissue characterization (e.g., iodine and fat quantification) and lesion detection, while substantially reducing radiation exposure and contrast agent usage. DECT-based techniques, such as virtual monochromatic imaging (VMI), are valuable for HCC detection, differential diagnoses, and noninvasive fibrosis assessments via extracellular volume (ECV) quantification. In MRI, quantitative biomarkers offer unparalleled insights: magnetic resonance elastography (MRE) accurately stages fibrosis by measuring liver stiffness; and proton density fat fraction (PDFF) precisely quantifies steatosis. Furthermore, gadoxetic acid-enhanced MRI markedly improves small lesion detection and enables quantitative, localized liver reserve capacity assessment. Collectively, these noninvasive and reproducible advances improve diagnostic accuracy, support early intervention, and optimize personalized treatment strategies. These innovations are driving a shift toward precision hepatology and are setting the stage for the next generation of liver imaging.