Mitigating Disparities in MASLD: Advancing Early Image Detection and Management

San Diego, CA | April 29, 2025—According to the Summa Cum Laude Award-Winning Online Poster presented during the 2025 ARRS Annual Meeting, patients with metabolic risk factors and an image diagnosis of steatosis—but without a recognized diagnosis of metabolic-associated steatotic liver disease (MASLD)—were more likely to experience significant complications of chronic liver disease, including cirrhosis and hepatocellular carcinoma (HCC), when compared to patients with a formal MASLD diagnosis.

A public health crisis with significant morbidity and mortality implications, “MASLD affects approximately one-fourth of the global population, making it the most chronic liver disease worldwide,” noted lead investigator Emmanuel Mgboji of the University of Michigan Medical School.

Using data from his institution’s EMR (Fig. 1), Mgboji and fellow Michigan researcher Jessica Fried, MD, identified a cohort of 10,280 subjects with a formal diagnosis of MASLD and 5,103 subjects without a formal MASLD diagnosis but with MRI evidence of hepatic steatosis and metabolic risk factors. After demographic extraction and comparison, Mgboji and Fried monitored each cohort for progression of disease-related outcomes from 2018 to 2023, including HCC, cirrhosis, myocardial infarction (MI), chronic kidney disease (CKD), coronary artery disease (CAD), type 2 diabetes mellitus (T2DM). Then, after comparing the incident rate and relative risk for each cohort, subjects were stratified by race (n = MASLD Dx; n = Image Dx cohort), including Caucasian Americans (CAs) (n = 8,548; n = 4,227), African Americans (AAs) (n = 580; n = 399), Asian American (ASAs) (n = 599; n = 229), and Hispanic Americans (HA) (n = 433; n = 169).

“Comparing incidence rates between the MASLD Dx and Image Dx cohorts (no MASLD Dx cohort),” Mgboji said, “we found a significant relative risk of 2.185 (95% CI: 1.6822–2.8395, p < 0.0001) for a diagnosis of HCC in the Image Dx cohort. Additionally, the relative risk of developing cirrhosis in the Image Dx cohort was 1.459 (95% CI: 1.2934–1.6461, p < 0.0001).” Mgboji and Fried also assessed the risk of being diagnosed with MI, CKD, CAD, and T2DM in the Image Dx cohort, with a relative risk of 1.236 (p = 0.0496), 1.240 (p = 0.0002), 1.346 (p < 0.0001), and 1.259 (p < 0.0001), respectively.  

“Further significant differences were observed when patients were stratified by racial groups,” added Mgboji. For developing HCC, the relative risk was 2.465 (p < 0.0001) in CAs, 3.488 (p = 0.0180) in AAs, 1.962 (p = 0.375) in ASAs, and 4.270 (p = 0.0451) in HAs. For cirrhosis, relative risk values were 1.590 (p < 0.0001) CAs, 1.817 (p = 0.0248) for AAs, 1.933 (p = 0.0336) for ASAs, and 2.795 (p = 0.0003) for HAs.

North America’s first radiological society, the American Roentgen Ray Society (ARRS) remains dedicated to the advancement of medicine through the profession of medical imaging and its allied sciences. An international forum for progress in radiology since the discovery of the x-ray, ARRS maintains its mission of improving health through a community committed to advancing knowledge and skills with the ARRS Annual Meeting, two radiology journals—American Journal of Roentgenology (AJR) and Roentgen Ray Review (R3)—InPractice magazine, ARRS Symposia, free-access multimedia from our Global Partner Societies, as well as awarding scholarships via The Roentgen Fund®.

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