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Diagnostics
Volume 16
Issue 12
10.3390/diagnostics16121854
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Review

Summary of Guidelines for Identifying and Risk-Stratifying Patients with Metabolic Dysfunction-Associated Steatotic Liver Disease: A Primer for Family Physicians

by
Mitchell P. Wilson
1,*,
Abdel-Aziz Shaheen
2,
Victoria Leung
3,
An Tang
4,
Andreu F. Costa
5,
Casey Hurrell
6 and
Gavin Low
1
1
Department of Radiology and Diagnostic Imaging, University of Alberta, 2B2.41 WMC, 8440-112 Street NW, Edmonton, AB T6G 2B7, Canada
2
Division of Gastroenterology, Department of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada
3
Department of Family Medicine, Faculty of Medicine and Dentistry, University of Alberta; 6-10 University Terrace, Edmonton, AB T6G 2T4, Canada
4
Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, 1000 R. Saint-Denis, Montreal, QC H2X 0C1, Canada
5
Department of Diagnostic Radiology, Faculty of Medicine, Dalhousie University, Halifax, NS B3H 4R2, Canada
6
Canadian Association of Radiologists, 220 Ave. Laurier #1120, Ottawa, ON K1P 6E6, Canada
*
Author to whom correspondence should be addressed.
Diagnostics 2026, 16(12), 1854; https://doi.org/10.3390/diagnostics16121854 (registering DOI)
Submission received: 26 April 2026 / Revised: 1 June 2026 / Accepted: 3 June 2026 / Published: 15 June 2026
(This article belongs to the Special Issue Clinical Diagnosis and Management of Liver Diseases)
Versions Notes

Abstract

Multiple North American and European societies now endorse a combined serological and imaging-based clinical care pathway for non-invasive risk stratification of patients with metabolic dysfunction-associated steatotic liver disease (MASLD). A multidisciplinary group of Canadian radiologists, hepatologists, family physicians, and other health professionals have recently published consensus guidelines for identification and risk stratification of patients with suspected MASLD. Screening should be performed with the FIB-4 score, and those with an indeterminate FIB-4 (between 1.32.67) should undergo imaging-based liver stiffness evaluation either with transient elastography (FibroScan), ultrasound shear wave elastography, or magnetic resonance elastography as a second step. While the implementation of these techniques for measuring liver stiffness differ, there is no clinically significant difference in their diagnostic performance. This narrative review, intended for Family Physicians, summarizes recommendations for serological investigations and imaging modalities of liver steatosis and stiffness. Practical guidance includes an algorithm with thresholds. We discuss current challenges and future directions of risk-stratifying patients with MASLD in the community.
Keywords: liver; MASLD; NAFLD; risk stratification; FibroScan; transient elastography; shear wave elastography; MR elastography liver; MASLD; NAFLD; risk stratification; FibroScan; transient elastography; shear wave elastography; MR elastography

Share and Cite

MDPI and ACS Style

Wilson, M.P.; Shaheen, A.-A.; Leung, V.; Tang, A.; Costa, A.F.; Hurrell, C.; Low, G. Summary of Guidelines for Identifying and Risk-Stratifying Patients with Metabolic Dysfunction-Associated Steatotic Liver Disease: A Primer for Family Physicians. Diagnostics 2026, 16, 1854. https://doi.org/10.3390/diagnostics16121854

AMA Style

Wilson MP, Shaheen A-A, Leung V, Tang A, Costa AF, Hurrell C, Low G. Summary of Guidelines for Identifying and Risk-Stratifying Patients with Metabolic Dysfunction-Associated Steatotic Liver Disease: A Primer for Family Physicians. Diagnostics. 2026; 16(12):1854. https://doi.org/10.3390/diagnostics16121854

Chicago/Turabian Style

Wilson, Mitchell P., Abdel-Aziz Shaheen, Victoria Leung, An Tang, Andreu F. Costa, Casey Hurrell, and Gavin Low. 2026. "Summary of Guidelines for Identifying and Risk-Stratifying Patients with Metabolic Dysfunction-Associated Steatotic Liver Disease: A Primer for Family Physicians" Diagnostics 16, no. 12: 1854. https://doi.org/10.3390/diagnostics16121854

APA Style

Wilson, M. P., Shaheen, A.-A., Leung, V., Tang, A., Costa, A. F., Hurrell, C., & Low, G. (2026). Summary of Guidelines for Identifying and Risk-Stratifying Patients with Metabolic Dysfunction-Associated Steatotic Liver Disease: A Primer for Family Physicians. Diagnostics, 16(12), 1854. https://doi.org/10.3390/diagnostics16121854

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