From:  The transition from NAFLD to MASLD: implications for Diagnosis, Prognosis, and Clinical Management

 Non-invasive diagnostic tools and emerging biomarkers in MASLD.

Method/biomarkerPrincipleAdvantagesLimitationsReferences
Abdominal ultrasoundAssesses hepatic echogenicityInexpensive, widely availableLow sensitivity in obesity and < 20% steatosis[82, 83]
CAP (FibroScan®)Ultrasonographic liver attenuationSemi-quantitative; simultaneous fibrosis assessmentOperator-dependent, affected by high BMI[8486]
MRI-PDFFQuantifies hepatic fat fractionGold standard for steatosis; high sensitivityExpensive, limited access[87, 88]
FIB-4/NFSComposite scores from clinical and lab dataFibrosis risk stratification; suitable for outpatient useLimited accuracy in intermediate-risk cases[89, 90]
ELF scoreDirect measure of fibrogenesisHigh accuracy for fibrosisCostly, limited availability[91]
CK-18 fragmentsA marker of hepatocyte apoptosisDifferentiates MASH from simple steatosisVariable cut-offs, low standardization[95, 96]
miR-122/miR-34aLiver-specific microRNAsHigh potential for early diagnosisNot yet in routine clinical use[67]

BMI: body mass index; CAP: controlled attenuation parameter; CK-18: cytokeratin 18; ELF: enhanced liver fibrosis; FIB-4: fibrosis-4 index; MASH: metabolic dysfunction-associated steatohepatitis; MRI-PDFF: magnetic resonance imaging with proton density fat fraction; NFS: non-alcoholic fatty liver disease fibrosis score.