Magnetic resonance imaging-derived extracellular volume fraction mapping in metabolic dysfunction-associated steatotic liver disease reveals subclinical cardiac remodelling.

Metabolic dysfunction-associated steatotic liver disease (MASLD) is a systemic fibroinflammatory condition with elevated cardiovascular risk. This study primarily evaluated cardiac fibrosis using MRI-derived extracellular volume fraction (ECV), with hepatic and pancreatic fibrosis assessed as secondary aims, examining whether ECV mapping of the heart, liver, and pancreas reflects extracellular matrix remodeling in relation to liver fibrosis severity. Thirty-nine adults with biopsy-confirmed MASLD without clinical cardiovascular disease and 10 healthy controls underwent 3.0-Tesla MRI with contrast-enhanced T1 mapping to quantify ECV in the myocardium (n = 49), liver (n = 49), and pancreas (n = 29). In MASLD patients, fibrosis markers included the Fibrosis-4 index (FIB-4), liver stiffness measurement (LSM), and Enhanced Liver Fibrosis (ELF) test. Myocardial ECV was higher in patients with advanced fibrosis, defined by FIB-4 ≥ 2.67 (p = 0.046), LSM ≥ 12.5 kPa (p = 0.030), and ELF ≥ 9.8 (p = 0.036), and correlated with FIB-4 (r = 0.39, p = 0.012). Liver ECV was elevated in advanced fibrosis and correlated with portal pressure (r = 0.63), LSM (r = 0.60), and histological stage (r = 0.48). Pancreatic ECV was unrelated to liver fibrosis but correlated with HbA1c (r = 0.40). These findings suggest that multi-organ ECV mapping may reflect matrix remodeling and support MASLD risk stratification.