This systematic review and meta-analysis examined how reliably common noninvasive imaging technologies can detect change over time in people with metabolic dysfunction-associated steatotic liver disease (MASLD). The authors searched PubMed Central and MEDLINE (2015-2025) and identified 19 studies including 1040 individuals (mean age 45 years, 43% female). They reviewed repeatability data for MRI-based measures—iron-corrected T1 (cT1), liver fat content (LFC), and magnetic resonance elastography (MRE)—and ultrasound-based measures, including vibration-controlled transient elastography liver stiffness measurement (VCTE LSM), controlled attenuation parameter (CAP), and shear wave elastography.

The findings suggest that cT1 and LFC are the most reliable for longitudinal monitoring, with pooled different-day repeatability coefficients of 7% for cT1 and 12% for LFC, compared with 22% for MRE, 26% for CAP, and 73% for VCTE liver stiffness (median interval between repeat scans: 14 days). Same-day repeatability was consistently better across all tests, but the key clinical issue is whether variability stays below thresholds for meaningful treatment-related change. In that context, the repeatability ranges for MRE and VCTE LSM overlapped with previously reported responder thresholds (15% and 30%, respectively), which may make them less suitable for tracking individual patient change. By contrast, cT1 and LFC variability remained below established meaningful-change thresholds (9% and 30%, respectively), supporting their potential value as more dependable tools for monitoring liver health over time in people living with MASLD/MASH.

Reference: Ndaa M, Pandya PK, Swensson J, et al. Reliable Monitoring of Patients With Metabolic Dysfunction-Associated Steatotic Liver Disease Using Imaging: A Systematic Literature Review and Meta-Analysis on Measurement Repeatability. Endocr Pract. 2026 Feb;32(2):258-267. doi: 10.1016/j.eprac.2025.09.205. Epub 2025 Oct 1. PMID: 41043587.

This phase 2, multicenter, randomized, double-blind, placebo-controlled, dose-finding trial evaluated the efficacy and safety of once-weekly subcutaneous tirzepatide (5 mg, 10 mg, or 15 mg) in adults with biopsy-confirmed metabolic dysfunction-associated steatohepatitis (MASH) and stage F2 or F3 fibrosis (moderate-to-severe fibrosis). Participants were treated for 52 weeks, and the primary end point was resolution of MASH without worsening of fibrosis. A key secondary end point was at least a one-stage improvement in fibrosis without worsening of MASH. Of the 190 participants randomized, 157 had Week 52 liver-biopsy results that could be evaluated. Missing biopsy data were imputed using an assumption based on placebo-group outcomes.

Tirzepatide was more effective than placebo for the primary end point, with a clear dose-response trend: 10% of participants in the placebo group achieved MASH resolution without fibrosis worsening, compared with 44% in the 5-mg group, 56% in the 10-mg group, and 62% in the 15-mg group (all comparisons vs placebo, P<0.001). Tirzepatide also improved the key fibrosis-related secondary outcome: 30% of placebo-treated participants had at least a one-stage fibrosis improvement without worsening of MASH, compared with 55%, 51%, and 51% in the 5-mg, 10-mg, and 15-mg tirzepatide groups, respectively. Overall, the findings suggest tirzepatide may be a promising treatment option for MASH with moderate-or-severe fibrosis, though the authors emphasize that larger and longer-term studies are needed to better define durability, safety, and clinical outcomes.

Reference: Loomba R, Hartman ML, Lawitz EJ, et al. Tirzepatide for Metabolic Dysfunction-Associated Steatohepatitis with Liver Fibrosis. N Engl J Med. 2024 Jul 25;391(4):299-310. doi: 10.1056/NEJMoa2401943. Epub 2024 Jun 8. PMID: 38856224.

The updated American Association for the Study of Liver Diseases (AASLD) nonalcoholic fatty liver disease (NAFLD) guidance reflects major advances since 2018, especially in noninvasive risk stratification and emerging therapeutics. NAFLD remains common and often underdiagnosed, with prevalence rising alongside obesity and metabolic disease. Fibrosis stage remains the strongest predictor of outcomes, and patients with “at-risk” nonalcoholic steatohepatitis (NASH)—NASH with at least F2 fibrosis—face higher risk of cirrhosis and liver-related complications. The document also highlights disease heterogeneity driven by insulin resistance, adipose dysfunction, diet, genetics, and environmental factors.

A key clinical shift is the stronger emphasis on noninvasive tests over biopsy for many decisions: FIB-4 is recommended as first-line risk assessment, with VCTE, ELF, or MRE used for secondary stratification when needed. High-risk groups (such as patients with T2DM, medically complicated obesity, family history of cirrhosis, or significant alcohol use) should be screened for advanced fibrosis, while general population screening is not recommended. Management remains multidisciplinary, centered on lifestyle change, alcohol assessment, and aggressive treatment of metabolic/CVD comorbidities, with surveillance for cirrhosis complications when present. There are still no FDA-approved drugs specifically for NAFLD/NASH, but some therapies used for diabetes/obesity may benefit selected patients. Statins are emphasized as safe and important for CVD risk reduction across the disease spectrum.

Reference: Rinella ME, Neuschwander-Tetri BA, Siddiqui MS, et al. AASLD Practice Guidance on the clinical assessment and management of nonalcoholic fatty liver disease. Hepatology. 2023 May 1;77(5):1797-1835. doi: 10.1097/HEP.0000000000000323. Epub 2023 Mar 17. PMID: 36727674; PMCID: PMC10735173.