A Hepatology review summarises MRI-based biomarkers in metabolic dysfunction-associated steatotic liver disease, which affects up to 38% of people globally.
MRI proton density fat fraction is the most accurate non-invasive measure of steatosis, with grade thresholds of 6.4%, 17.4% and 22.1%; a relative fall of 30% or more is associated with histological response. Magnetic resonance elastography is the most accurate imaging test for fibrosis: about 3.1–4.4 kPa corresponds to F2–F3 and 5 kPa or more to cirrhosis, and each 1-kPa increase is associated with a 43% higher risk of decompensation. Composite scores combining imaging and blood tests add to diagnosis.
MRE is not widely available in India, and transient elastography remains the practical test. But the thresholds help interpret MRI reports and trial results for the newly approved MASH therapies.
- A 30% relative fall in MRI fat fraction is associated with histological response
- MR elastography of 5 kPa or more suggests cirrhosis
- Each 1-kPa rise in MR stiffness is linked to a 43% higher decompensation risk
- Transient elastography remains the practical first-line fibrosis test where MRE is unavailable
Why it matters
Non-invasive markers are becoming the way MASH treatment response is judged.
The statistics, in plain English
A 43% higher risk per 1 kPa means stiffness acts as a graded risk marker: each step up adds risk, rather than there being one safe cut-off.
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