Non-invasive assessment of liver fibrosis in MASLD: the need of sex-adjusted scores

Introduction
Metabolic dysfunction-associated steatotic liver disease (MASLD) encompasses a spectrum of conditions from simple steatosis to advanced fibrosis that may represent the cradle for hepatocellular carcinoma. Thus, an accurate assessment of fibrosis is critical for patient management. Noninvasive tools, including serum biomarkers and imaging techniques, have emerged as practical alternatives to liver biopsy, which presents limitations for invasiveness, cost, and sampling variability.

Areas covered
In this review, we examined references from relevant articles on PubMed, to investigate the most used noninvasive scores, focusing on their specific applications in various pathological conditions, including those beyond the liver. The application of these tools is particularly vital in challenging subpopulations, where conventional metabolic risk factors may be absent, or to target new therapeutical approaches. Sex-specific differences in hormonal and metabolic profiles, however, influence fibrosis progression and the interpretation of noninvasive tools, necessitating further refinement to optimize their clinical utility.

Expert opinion
Despite these complexities, integrating noninvasive scores with imaging techniques has proven effective in stratifying risk, guiding treatment decisions, and improving long-term outcomes. As research continues to enhance these tools, their routine use in clinical practice represents a cornerstone for the early detection, monitoring, and personalized management of MASLD with sex-specific cutoffs.