What question did this study set out to answer?

The central aim is to develop a fat-corrected virtual MRE framework to assess liver fibrosis in patients with metabolic dysfunction-associated steatotic liver disease.

April 20, 2026Open Access

Development and validation of fat-corrected virtual MR elastography to assess fibrosis stage in metabolic dysfunction-associated steatotic liver disease

Key Points

The central aim is to develop a fat-corrected virtual MRE framework to assess liver fibrosis in patients with metabolic dysfunction-associated steatotic liver disease.
463 MASLD patients underwent multi-b-value diffusion-weighted imaging and conventional magnetic resonance elastography.
ADC parameters were calculated with and without fat correction to derive virtual MRE and fat-corrected virtual MRE.
Diagnostic performance of virtual MRE, fat-corrected virtual MRE, and traditional MRE was compared in a validation cohort.
Fat-corrected virtual MRE demonstrated superior agreement with standard MRE across all fibrosis stages.
The new framework achieved significant diagnostic performance improvements for detecting advanced fibrosis and cirrhosis.
FC-vMRE showed promising diagnostics with AUCs of 0.761 for ≥ F2, 0.756 for ≥ F3, and 0.838 for cirrhosis.

Abstract

Abstract Objectives This study aimed to develop and validate a fat-corrected virtual magnetic resonance elastography (FC-vMRE) framework based on diffusion-weighted imaging (DWI) to assess liver fibrosis in patients with metabolic dysfunction-associated steatotic liver disease (MASLD). Materials and methods A total of 463 MASLD patients underwent multi- b -values (0–1500 s/mm²) DWI acquisition, proton density fat fraction (PDFF), and conventional magnetic resonance elastography (MRE). Apparent diffusion coefficient (ADC) parameters were calculated with or without fat correction (based on PDFF). Using the training cohort ( n = 361), ADC-to-MRE formulas were derived to compute virtual MRE (vMRE) and FC-vMRE. In the validation cohort ( n = 102, with biopsy), the diagnostic performance of vMRE, FC-vMRE, and MRE for fibrosis staging was compared. Results ADC 200-1200 demonstrated the strongest correlation with MRE values ( R = −0.706, p < 0.001), yielding the formula: FC-vMRE = 6.50 − 3.13 × ADC w . Compared with vMRE, FC-vMRE showed superior agreement with MRE (bias: −0.001 kPa vs 0.469 kPa; intraclass correlation coefficient: 0.666 vs 0.381). In staging performance, FC‑vMRE significantly outperformed vMRE across all fibrosis stages. FC-vMRE showed promising diagnostic performance to MRE in detecting ≥ F2 fibrosis (AUC: 0.761 vs 0.848, p = 0.053), ≥ F3 fibrosis (AUC: 0.756 vs 0.818, p = 0.066), and cirrhosis (AUC: 0.838 vs 0.914, p = 0.065). Conclusion FC-vMRE provides a clinically promising alternative requiring only standard MRI equipment, effectively correcting for fat-related confounding in MASLD, and demonstrating encouraging diagnostic concordance with MRE and histology. This approach shows potential for broader clinical implementation. Critical relevance statement Fat-corrected virtual MRE using diffusion-weighted imaging provides promising fibrosis staging accuracy to conventional magnetic resonance elastography in metabolic dysfunction-associated steatotic liver disease patients without requiring specialized hardware. Key Points Fat infiltration confounds diffusion measurements in metabolic steatotic liver disease. Fat-corrected virtual MRE showed superior agreement with standard MRE. Hardware-free fibrosis assessment enables accessible liver stiffness measurement. Graphical Abstract

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