LITMUS study in The Lancet: blood and scan tests can reliably spot advanced liver scarring in fatty liver disease, reducing the need for biopsy

Metabolic dysfunction-associated steatotic liver disease (MASLD) affects up to one in three adults worldwide. Judging how far it has progressed has usually meant a liver biopsy. Two studies from the European LITMUS consortium, published on 29 October 2026 in The Lancet and Nature Medicine, tested which non-invasive tests can replace it.

The studies

• LITMUS Study (The Lancet): a prospective, multicentre diagnostic-accuracy study comparing blood tests and ultrasound-based liver stiffness with expert-read biopsy in more than 1,500 patients.
• LITMUS Imaging Study (Nature Medicine): advanced MRI and elastography in more than 350 patients.

Key findings

• For advanced fibrosis and cirrhosis, the SOMAScan proteomic panel, MR elastography and FibroScan-based tools (including the Agile 3+ score) were the most accurate.
• ELF and ADAPT blood tests also passed preset thresholds for cirrhosis.
• For “at-risk MASH”, the group targeted by drug trials, only SOMAScan met the threshold — so biopsy will likely remain necessary for trial enrolment for now.
• A simple, inexpensive gamma-GT blood test outperformed the widely used FIB-4 score as a first-line test.
• MR elastography outperformed FibroScan liver stiffness for advanced fibrosis.

The authors propose a pathway: gamma-GT first, then ELF or FibroScan, with advanced imaging in specialist care. “For advanced liver scarring and cirrhosis, we now have tools good enough to use with real confidence,” said joint senior author Prof. Quentin Anstee of Newcastle University.

Limitations

These are diagnostic-accuracy studies against biopsy, which is itself an imperfect reference standard; patients were largely recruited in specialist centres, so performance in primary care may differ; the proposed pathway still needs further validation; and some tests (SOMAScan, MRE) are costly or not widely available. This summary is based on the publication details and Newcastle University’s release. Questions about liver testing should be discussed with a doctor.