What Can We Learn From Longitudinal Measurements of Liver Stiffness in Metabolic Dysfunction‐Associated Steatotic Liver Disease?

Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most prevalent chronic liver disease worldwide and can potentially progress to fibrosis, cirrhosis, hepatocellular carcinoma and liver failure. Vibration-controlled transient elastography allows regular, non-invasive assessment of fibrosis through the liver stiffness measurement (LSM). Currently, static measurements are mainly used, whereas longitudinal assessment may better capture disease evolution and response to treatment. This review synthesises the available evidence on longitudinal LSM changes in observational studies and discusses study designs, clinical outcomes, including liver-related events (LREs), thresholds and the potential influence on clinical decisions. Across studies, there is considerable variation in terms of hepatic disease severity, follow-up intervals and definition of LSM thresholds. A relative change of 20% in LSM is most commonly used to determine three groups of patients based on their clinical evolution: improvers, stable and progressors. Most studies report that LSM progression is associated with an increased risk of LREs and extra-hepatic complications (cardiovascular events, intramuscular fat and type 2 diabetes). In conclusion, monitoring dynamic changes in LSM provides good risk stratification, complements static measurements and can optimise the management of patients with MASLD. However, further studies with longer and standardised follow-up are needed, as well as including the full spectrum of MASLD forms.