Metabolic dysfunction-associated steatotic liver disease (MASLD) has become one of the most common chronic liver conditions worldwide. A smaller but clinically critical subset of these patients progress to metabolic dysfunction-associated steatohepatitis (MASH), a stage marked by inflammation, hepatocellular injury, and fibrosis. Early identification of patients at risk of MASH is essential, yet liver biopsy the current reference standard remains invasive, costly, and impractical for large-scale screening.
Recent evidence now strengthens the role of MRI-based, non-invasive diagnostics in closing this gap.
A literature review led by Shyna Zhuoying Gunalan (National University of Singapore) and published in the American Journal of Gastroenterology (January 13, 2026) evaluated MRI techniques for identifying MASLD patients at risk of MASH, defined by a MASH Activity Score (MAS) ≥ 4. The review analyzed 20 studies involving 9,480 participants, sourced from Medline and Embase databases up to December 2024.
Two MRI-based strategies were assessed in detail:
Focused Abbreviated Survey MRI (FAST)
FAST integrates MRI-proton density fat fraction, liver stiffness, and AST levels to identify patients with active steatohepatitis and fibrosis.
High ruling-out sensitivity: 87%
Moderate specificity: 57%
High ruling-in specificity: 90%, though with reduced sensitivity (44%)
These results indicate FAST is particularly effective for excluding low-risk patients and may be suitable for population-level screening due to its accessibility and efficiency.
MEFIB (MR Elastography + FIB-4 Index)
This combined approach pairs imaging-based stiffness measurements with a validated serum fibrosis score.
Ruling-out sensitivity: 81%
Specificity: 60%
Ruling-in specificity: 87%, sensitivity 50%
MEFIB demonstrated strong performance in confirming high-risk disease, supporting its use in secondary risk stratification and referral pathways.
The findings directly address a long-standing clinical need. As the authors emphasize, accurate non-invasive tools are essential for identifying patients who require closer monitoring or early therapeutic intervention, particularly as pharmacologic options for MASH continue to advance.
From a healthcare systems perspective, these MRI-based tools may reduce unnecessary biopsies, improve patient acceptance, and enable earlier disease interception—especially important given the rising global burden of metabolic disease.
Key takeaway: FAST and MEFIB are no longer experimental concepts; they are evidence-supported tools with clearly defined diagnostic strengths that can complement existing clinical workflows.
MBH/AB