Liver stiffness measurement and its longitudinal change by Magnetic Resonance Elastography predicts hepatocellular carcinoma in MASLD

Motivation: Nearly 10-20% of hepatocellular carcinoma (HCC) occurs in non-cirrhotic livers, especially in MASLD, highlighting the need for reliable noninvasive HCC risk prediction. Goal(s): To evaluate the role of MR Elastography (MRE) in predicting HCC development in MASLD patients. Approach: The retrospective study included 7,305 MASLD patients, of whom 150 (2.1%) developed HCC and 1,189 had serial MREs. Results: Liver stiffness measurement (LSM) is a significant predictor of future HCC in a multivariable Cox model (hazard ratio = 1.21, P<0.001). Among patients with serial MRE measurements, those with disease progression (ΔLSM ≥ 0.44 kPa/year) had a substantially higher risk of HCC development (P=0.001). Impact: Our study highlights the value of MRE-based LSM and ΔLSM in predicting HCC risk in MASLD patients, providing a tool for identifying high-risk individuals and guiding personalized clinical management.