AASLD-INASL Joint Webinar: Advances in MASH Diagnosis and Treatment (ondemand)-Diagnostic Advances & Risk Stratisfication

Diagnostic Advances & Risk Stratisfication

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The document summarizes a World MASH Day 2026 webinar on <strong>diagnostic advances and risk stratification in MASLD</strong>. It highlights that MASLD is highly prevalent in India, affecting both adults and children, and emphasizes that <strong>fibrosis stage is the key determinant of liver-related death and decompensation</strong>.

A major focus is the growing role of <strong>non-invasive tests (NITs)</strong> for assessing steatosis, inflammation, MASH, and fibrosis. These include commonly used tools such as <strong>ultrasound, VCTE, MRI-based methods, CAP, MRE, FIB-4, APRI, ELF</strong>, and newer composite scores and imaging biomarkers. The webinar notes that liver biopsy remains the gold standard, but has important limitations, making NIT validation essential.

The presentation explains the <strong>“rule-out” and “rule-in” approach</strong> for NITs: high-sensitivity tests help exclude advanced fibrosis, while high-specificity tests help confirm disease, though false positives remain a concern. NITs are especially useful in <strong>high-risk groups</strong> such as patients with diabetes, obesity/overweight, and transaminitis. Data from Indian cohorts show a substantial burden of fibrosis in diabetes and discuss disease severity in lean versus non-lean MASLD.

NITs are also increasingly important for <strong>clinical trials and treatment decisions</strong>, including sequential testing to reduce trial screen failure and using imaging or biomarker changes as surrogate endpoints. The document notes that NITs can help predict <strong>clinical outcomes</strong> such as liver-related events, cirrhosis, and decompensation, but performance for non-liver outcomes like cardiovascular events and cancer is less reliable.

The take-home message is that <strong>NITs are central to MASLD risk stratification</strong>, but cutoffs, reproducibility, and prognostic thresholds still need validation. Future directions include <strong>personalized fibrosis monitoring, multi-omics, and AI-based models</strong>.

Keywords

MASLD

non-invasive tests

fibrosis

risk stratification

MASH

liver biopsy

VCTE

FIB-4

ELF

diagnostic advances