Volume 32, Issue 2, February 2026, Pages 258-267Author links open overlay panel, , , , , , , AbstractIntroduction

As treatments for patients with metabolic dysfunction-associated steatotic liver disease (MASLD) emerge, patient eligibility assessment and monitoring is increasingly important. To assess the reliability of noninvasive imaging technologies in MASLD, we systematically reviewed the literature for studies on technical repeatability.

Methods

PubMed Central and MEDLINE were searched (2015-2025) for studies in MASLD that examined the repeatability of: magnetic resonance-derived iron-corrected T1 (cT1), liver fat content (LFC), and magnetic resonance elastography (MRE); ultrasound-based vibration controlled transient elastography liver stiffness measurement (VCTE LSM), controlled attenuation parameter and shear wave elastography. The relative repeatability coefficient (%RC) for same-day or different-day (%RCDD) repeat tests were summarized, and available data pooled using random-effects-meta-analysis.

Results

Our search identified 19 studies including 1040 individuals (mean age 45 years; 43% female). The pooled random-effects average %RCDD was 7% for cT1, 12% for LFC, 22% for MRE, 73% for VCTE LSM, and 26% for controlled attenuation parameter, with a median interval of 14 days between repeat scans. Relative repeated measures on the same day values were consistently lower across all tests. In the context of MASLD monitoring, the %RCDD for MRE and VCTE LSM overlapped with previously reported thresholds for clinically-meaningful change for treatment responders (15% and 30%, respectively). In contrast, the %RCs for cT1 and LFC were below established thresholds for clinically-meaningful change (9% and 30%, respectively).

Conclusion

This systematic review and meta-analysis showed that cT1 and LFC are more reliable in detecting change in liver health in people living with MASLD-metabolic dysfunction-associated steatohepatitis, compared to liver stiffness. Liver stiffness measurements are less suited to monitoring individual patients.

Graphical abstractDownload: Download high-res image (312KB)Download: Download full-size imageKey words

liver stiffness measurement (MRE, VCTE, SWE)

metabolic dysfunction-associated steatohepatitis (MASH)

metabolic dysfunction-associated steatotic liver disease (MASLD)

noninvasive imaging biomarkers

multiparametric magnetic resonance imaging (cT1, PDFF)

repeatability and reproducibility

AbbreviationsCAP

controlled attenuation parameter

ICC

intraclass correlation coefficient

LSM

liver stiffness measurement

MASLD

metabolic dysfunction-associated steatotic liver disease

MASH

metabolic dysfunction-associated steatohepatitis

MRE

magnetic resonance elastography

RC

repeatability coefficient

RCDD

repeated measures on the different day

RCSD

repeated measures on the same day

SWE

shear wave elastography

VCTE

vibration-controlled transient elastography

wCV

within-subject coefficient of variation

wSD

within-subject standard deviation

© 2025 AACE. Published by Elsevier Inc.