Part 2: CAR Metabolic Dysfunction-Associated Steatotic Liver Disease Working Group Recommendations for Risk Stratifying Patients With MASLD

The Canadian Association of Radiologists (CAR) metabolic dysfunction-associated steatotic liver disease (MASLD) Working Group (WG) is a multidisciplinary working group composed of radiologists, hepatologists, and family physicians. In this 3-part series, we provide Delphi consensus-based guidance on clinical and imaging findings for patients with known or suspected MASLD (formerly termed nonalcoholic fatty liver disease or NAFLD). Part 1 focuses on the detection and grading of hepatic steatosis on imaging; Part 2 on risk-stratification of patients with MASLD, including a patient pathway using serological and imaging investigations; and Part 3 on the implementation of practice recommendations for quality assurance using shear wave elastography (SWE) and magnetic resonance elastography (MRE) programs. In Part 2 of these guidelines, the WG provides 14 recommendations for risk stratifying MASLD patients into low and high risk for advanced hepatic fibrosis ( F ≥ 3) using a combination of serological and imaging investigations. Population screening and risk stratification of MASLD patients using a clinical and serological investigation (FIB-4) followed by imaging pathway is recommended. Clinical, technical, and grading recommendations for point shear wave elastography (pSWE), 2-dimensional SWE (2D-SWE), and MRE are discussed.