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Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most prevalent chronic liver disorder worldwide, reflecting the growing prevalence of obesity and type 2 diabetes. Some patients progress to metabolic dysfunction-associated steatohepatitis (MASH), which is linked to cirrhosis, liver failure and hepatocellular carcinoma. The recent approval of resmetirom and semaglutide1 2 for active, fibrotic MASH (F2–F3) highlights the urgent need for accurate, non-invasive tests (NITs). Current guidelines recommend using tools such as the FIB-4 index and liver stiffness measurement by vibration-controlled transient elastography (VCTE) to rule out/rule in advanced fibrosis. However, these NITs have limited ability to identify patients with fibrotic MASH who may be prioritised for novel pharmacological therapies.3 4