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The diagnosis of NASH is critically important for clinical trials and clinical practice. Today, the gold standard to diagnose NASH is a liver biopsy, as it’s the most complete diagnostic solution allowing clinicians to study key characteristics of the disease. But it has limitations. Liver biopsies require significant expertise both to perform but also to interpret the results. Biomarkers could play an important role and imaging biomarkers (transient elastography and shear-wave) plus MRI techniques allow assessment of liver damage in NAFLD with high diagnostic accuracy.