Superiority of magnetic resonance elastography and proton density fat fraction: an umbrella meta-analysis of non-invasive imaging for hepatic steatosis and fibrosis in metabolic dysfunction-associated steatotic liver disease and chronic hepatitis B
Year: 2026
Type: review
Abstract: Background: Various quantitative techniques based on ultrasound (US) and magnetic resonance imaging (MRI) have been widely used to assess hepatic steatosis and fibrosis. This study thus aimed to synthesize and critically evaluate the evidence derived from systematic reviews on the diagnostic performance of noninvasive imaging techniques including transient elastography (TE), point shear wave elastography (pSWE), two-dimensional shear wave elastography (2D-SWE), magnetic resonance elastography (MRE), controlled attenuation parameter (CAP), and proton density fat fraction (PDFF) for liver fibrosis and steatosis in patients with metabolic dysfunction-associated steatotic liver disease (MASLD) and chronic hepatitis B (CHB). Methods: Searches were performed on PubMed, Embase, the Web of Science, and Cochrane Library from database inception until 2 March 2025, including keywords 'liver diseases', imaging', 'systematic review' and others. We included systematic reviews that comprised studies evaluating the diagnostic performance of non-invasive imaging techniques for liver fibrosis or steatosis in patients with MASLD or CHB. Results: Thirty-five reviews were included from 3,752 articles. For hepatic steatosis assessment, PDFF demonstrated high diagnostic stability, while CAP showed good screening performance for mild steatosis. For liver fibrosis assessment, MRE exhibited high diagnostic accuracy for significant (≥F2), advanced (≥F3) fibrosis, and cirrhosis (F4). In obese MASLD patients, MRE demonstrated superior specificity compared to TE. Among CHB patients, MRE displayed particularly high diagnostic performance. Other techniques (2D-SWE, TE) remained clinically valuable in specific stages and patient populations. Conclusions: MRE performance varied between the two etiologies, suggesting liver stiffness is a composite biomarker. PDFF provides precise quantification of steatosis, while CAP is suitable for screening mild cases. The findings emphasize the necessity of developing personalized imaging strategies based on etiology to optimize patient management and reduce reliance on liver biopsy.
Authors: Xingyue Li, Dawei Yang, Zhenghan Yang
Institutions: Capital Medical University, Beijing Friendship Hospital
Language: English
Subfield: Hepatology
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7223205351