Chronic liver disease (CLD) causes approximately two million deaths annually and presents a major global health burden. Because most severe outcomes—like liver failure, portal hypertension, and hepatocellular carcinoma—occur in those with advanced fibrosis, early detection is essential. While liver biopsy has been the traditional standard, its invasiveness has led to the development of noninvasive liver disease assessments (NILDA), including blood- and imaging-based tools. To guide clinical practice, the American Association for the Study of Liver Diseases (AASLD) convened a multidisciplinary panel to develop evidence-based recommendations for imaging-based NILDA, using both systematic review and expert consensus. The result is a framework of graded and ungraded guidance to support clinicians in fibrosis and steatosis assessment.

The panel recommends imaging-based NILDA as the first-line approach for detecting moderate to advanced fibrosis in patients with CLD. Despite their diagnostic accuracy, adoption of NILDA remains limited due to cost, access, and payer recognition. The guidelines stress expanding use among high-risk populations, including those with metabolic syndrome or untreated hepatitis. Further research is needed to validate NILDA in newly defined disease categories such as MAFLD, and to explore tools like machine learning and multiomics for improving diagnostic precision. The authors call for a shift from static, histology-based assessment toward dynamic models linked to clinical outcomes, advancing precision liver care.

Reference: Sterling RK, Duarte-Rojo A, Patel K, et al. AASLD Practice Guideline on imaging-based noninvasive liver disease assessment of hepatic fibrosis and steatosis. Hepatology. 2025 Feb 1;81(2):672-724. doi: 10.1097/HEP.0000000000000843. Epub 2024 Mar 15. PMID: 38489518.