Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) is a major cause of chronic liver disease, requiring reliable methods for early fibrosis detection. The Fibrosis-4 (FIB-4) index is widely used for initial risk stratification.
Objective: To critically review the diagnostic performance, strengths, limitations, and clinical applications of FIB-4 and other non-invasive fibrosis assessment methods in MASLD.
Review Methodology: FIB-4 offers an accessible, cost-effective first-line assessment but has limitations related to age, diabetes, disease prevalence, and clinical setting. Secondary tests, including vibration-controlled transient elastography, shear-wave elastography, the Enhanced Liver Fibrosis test, and magnetic resonance elastography, may improve diagnostic accuracy when used sequentially.
Conclusion: FIB-4 should guide risk stratification rather than serve as a standalone diagnostic tool. Integrated assessment pathways and appropriate follow-up are essential for identifying advanced fibrosis and improving clinical management.
FIB-4 index, MASLD, liver fibrosis, advanced liver fibrosis, non-invasive fibrosis assessment, transient elastography, shear-wave elastography, Enhanced Liver Fibrosis test, magnetic resonance elastography, metabolic dysfunction-associated steatotic liver disease, fibrosis risk stratification, liver disease diagnosis.