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The secondary stage in MASLD is steatohepatitis (MASH), the co\u2010existence of steatosis and inflammation, a leading cause of progression to fibrosis and mortality. MASH resolution alone improves survival. Currently, MASH diagnosis is via liver biopsy. This study sought to evaluate the accuracy of imaging\u2010based tests for MASH diagnosis, which offer a non\u2010invasive method of diagnosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Eight academic literature databases were searched and references of previous systematic reviews and included papers were checked for additional papers. Liver biopsy was used for reference standard.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We report on 69 imaging\u2010based studies. There were 31 studies on MRI, 27 on ultrasound, five on CT, 13 on transient elastography, eight on controlled attenuation parameter (CAP) and two on scintigraphy. The pathological definition of MASH was inconsistent, making it difficult to compare studies. 55\/69 studies (79.71%) were deemed high\u2010risk of bias as they had no preset thresholds and no validation. The two largest groups of imaging papers were on MRI and ultrasound. AUROCs were up to 0.93 for MRE, 0.90 for MRI, 1.0 for magnetic resonance spectroscopy (MRS) and 0.94 for ultrasound\u2010based studies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Our study found that the most promising imaging tools are MRI techniques or ultrasound\u2010based scores and confirmed there is potential to utilise these for MASH diagnosis. However, many publications are single studies without independent prospective validation. Without this, there is no clear imaging tool or score currently available that is reliably tested to diagnose MASH.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/liv.16127","type":"journal-article","created":{"date-parts":[[2024,10,14]],"date-time":"2024-10-14T06:28:58Z","timestamp":1728887338000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":23,"title":["Accuracy of Non\u2010Invasive Imaging Techniques for the Diagnosis of\n                    <scp>MASH<\/scp>\n                    in Patients With\n                    <scp>MASLD<\/scp>\n                    : A Systematic Review"],"prefix":"10.1111","volume":"45","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7051-8820","authenticated-orcid":false,"given":"Jennifer","family":"Cathcart","sequence":"first","affiliation":[{"name":"Division of Molecular and Clinical Medicine University of Dundee  Dundee UK"},{"name":"Gastroenterology Department Aberdeen Royal 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