Integrated serum metabolomics and MRI biomarkers for MASLD: a practical framework for noninvasive staging and monitoring.

BACKGROUND

Metabolic dysfunction-associated steatotic liver disease (MASLD) affects nearly one in four adults globally, yet early diagnosis remains challenging due to the limitations of current diagnostic modalities. While liver biopsy is the reference standard, its invasiveness limits its utility for population screening. Similarly, single-modality noninvasive tests often fail to distinguish inflammation from fibrosis or detect early metabolic injury. This review synthesized recent evidence (2020-2025) regarding the integration of serum metabolomic profiling with quantitative magnetic resonance imaging (MRI) biomarkers to enhance diagnostic precision.

RESULTS

Emerging data indicate that serum metabolite panels, which detect upstream metabolic dysregulation, are highly complementary to MRI-PDFF (steatosis quantification) and MR Elastography (stiffness/fibrosis measurement). Integrated panels have demonstrated Area Under the Receiver Operating Characteristic (AUROC) values exceeding 0.90 for detecting advanced fibrosis, outperforming individual methods.

CONCLUSIONS

We propose a three-tier clinical framework for integrating these biomarkers: transitioning from simplified biochemical screening in primary care to comprehensive multimodal staging in specialist centers, followed by risk-adapted longitudinal monitoring. This integrated approach offers a pathway toward precision hepatology, enabling earlier intervention and more accurate disease tracking without reliance on invasive procedures.