Current Update on Nomenclature, Diagnosis, and Management of Metabolic Dysfunction– associated Steatotic Liver Disease: Radiologists’ Perspective

Metabolic dysfunction–associated steatotic liver disease (MASLD) is the new name for nonalcoholic fatty liver disease (NAFLD). MASLD continues to be a significant global health care problem, commensurate with the increased prevalence of obesity and metabolic syndrome. The study of MASLD has intensified over the past 5 years, with major breakthroughs in understanding the pathogenesis and natural history. The American Association for the Study of Liver Diseases (AASLD) published practice guidance in 2023 to incorporate changes in diagnosis and management. A new nomenclature for MASLD, with updated definitions, has been approved through a global multisociety-led Delphi consensus to replace NAFLD with MASLD and nonalcoholic steatohepatitis (NASH) with metabolic dysfunction–associated steatohepatitis (MASH). AASLD practice guidelines on blood-based and imaging-based noninvasive liver disease assessments of hepatic fibrosis and steatosis have also been recently published. The latest advances in US and MRI techniques have allowed radiologists to play a pivotal role in early detection, accurate assessment, and monitoring of diseases, thus enabling timely intervention and lifestyle changes. Resmetirom has recently been approved for treating noncirrhotic adult patients with MASLD and moderate to severe hepatic fibrosis, along with diet and exercise. The authors review the role of imaging in the new guidelines as the current evaluation of MASLD transitions from invasive tests to advanced imaging-based diagnostics. The article will serve as a reference for radiologists, who play a critical role in managing and prognosticating MASLD.