Houston Methodist Pioneers Short Sequence MRI to Diagnose Fatty Liver Disease with Fibrosis

In a move poised to reshape the way clinicians screen for liver disease, Houston Methodist Hospital has unveiled a new short-sequence MRI protocol that diagnoses metabolic-associated steatotic liver disease (MASLD) with fibrosis in just 5 to 10 minutes — a sharp reduction from the traditional 30- to 40-minute scans.

Known as an "MASLD hepatogram," the innovative protocol offers a faster and more accessible way to identify patients at high risk of developing cirrhosis, a permanent, potentially fatal form of liver scarring typically associated with obesity, type-2 diabetes and high blood pressure, cholesterol and triglycerides.

"There's a large subset of patients with clinically silent fibrosis who won't get diagnosed until it's too late," said Dr. David Victor, a hepatologist at Houston Methodist. "By making the test faster, easier and more accessible, we're giving more people a chance to intervene while the disease is still reversible."

This streamlined MRI approach arrives at a critical time, shortly after the release of resmetirom (Rezdiffra), the first FDA-approved treatment for metabolic associated steatohepatitis (MASH) with fibrosis, the most advanced stage of MASLD.

Although more than 25% of all American adults are estimated to have MASLD, only 4% those will go on to develop MASH with fibrosis. Most have no idea they are at risk.

"Finally, there's a treatment that can offer hope to millions of Americans with advanced liver scarring, but it only works if we know who to use it on," said Dr. Victor. "That's the tricky part."

A curated test for a specific purpose

Unlike a full abdominal MRI, which captures a wide range of abdominal structures and typically requires contrast dye, an MASLD hepatogram targets only the liver's fat content and stiffness. It relies on two key techniques: MRI fat quantification and MR elastography, which uses gentle mechanical waves to measure liver stiffness — a correlate for fibrosis.

"It's essentially a curated exam," said Dr. Nakul Gupta, a diagnostic radiologist at Houston Methodist who helped develop the new protocol alongside Dr. Victor. "We narrowed it down to the essential sequences that answer one very specific question: does this patient have steatotic liver fibrosis?"

The test is to be performed without contrast or IV access and takes less than 10 minutes inside the MRI machine. This improves tolerability for patients with claustrophobia or chronic illness who may struggle with lengthy scans.

"This isn't a new machine or technology," Dr. Victor added. "It's about using what we already have — but in a way that is smarter."

Filling a critical gap in screening

Nonalcoholic fatty liver disease affects an estimated 1 in 3 to 1 in 2 adults globally. Of those, only a small fraction develop liver fibrosis, the progressive scarring that can eventually lead to cirrhosis and liver failure.

Historically, fibrosis screening has been underutilized, costly and often delayed, though the impact of such poor access was diminished because there wasn't an effective treatment for that patient population.

"If a patient didn't want to sit through a full 30-minute MRI, they might just skip the scan," said Dr. Gupta. "Now that we've eliminated waste and trimmed it to its most essential form, it's more palatable to use as a screening tool for those who qualify based on their blood test results."

Dr. Victor said the abbreviated scan could lead to a significant increase in compliance and outcomes. "If we identify fibrosis at stage F2 or F3, we can treat it with medication and lifestyle changes. But once it becomes cirrhosis — stage F4 fibrosis — it's likely permanent."

Enabling earlier treatment

The new protocol dovetails with the rollout of resmetirom, approved in 2024, the first drug to treat MASH with moderate to advanced fibrosis. Until now, there was little incentive to diagnose early-stage fibrosis, because treatment options were limited.

"The need for early identification has only recently become urgent," Dr. Victor said. "Now, for the first time, we have a therapy that can actually reverse or stabilize fibrosis."

Houston Methodist clinicians are actively encouraging referring physicians to consider assessing patient for fibrosis who have MASLD or risk factors like metabolic syndrome or elevated liver enzymes. Patients with an abnormal FIB-4 score (a screening index to assess the likelihood of advanced liver fibrosis) particularly should be considered for this unique scan.

"This isn't just about helping our own patients," explained Dr. Gupta. "Our goal is to lead by example and make this diagnostic approach more widely available. It's a smarter, more resource-conscious way to get patients the care they need — before it's too late."