Association Between Early and Long-Term Changes in Liver Stiffness in Patients with MASLD Undergoing Serial Magnetic Resonance Elastography

Background/Objectives: Magnetic resonance elastography (MRE) provides an accurate and reproducible non-invasive assessment of liver stiffness and fibrosis severity in metabolic dysfunction-associated steatotic liver disease (MASLD). Although longitudinal changes in liver stiffness have been associated with clinical outcomes, the association between short-term and longitudinal changes remains unclear. This study aimed to evaluate the association between short-term and long-term changes in MRE-derived liver stiffness in patients with MASLD undergoing serial MRE assessments. Methods: In this retrospective cohort study, 100 patients with MASLD who underwent three MRE examinations at approximately baseline, 1 year, and 3 years were analyzed. Early response was defined as a ≥19% reduction in liver stiffness at the second examination relative to baseline. The association between early response and long-term liver stiffness changes was evaluated using logistic regression analysis. Results: A total of 22 patients (22%) were classified as early responders. Early responders were significantly more likely to achieve a ≥19% reduction in liver stiffness at the third MRE compared with non-early responders (59% vs. 27%, p = 0.006). In multivariable analysis adjusting for baseline liver stiffness, early response remained independently associated with long-term improvement (odds ratio 3.41, 95% CI 1.18–9.86; p = 0.023). Higher baseline liver stiffness was also associated with subsequent improvement (OR per 1 kPa increase, 1.44, 95% CI 1.11–1.87; p = 0.006). Conclusions: Early reductions in liver stiffness measured by MRE were associated with subsequent long-term improvements in patients with MASLD, suggesting that short-term MRE changes may provide insight into subsequent longer-term stiffness changes.