In a biopsy-validated cohort of MASLD patients (n=399, with 235 T2D), combining LIVERFASt with Fibroscan correctly identified 95% of F3–F4 advanced fibrosis cases, outperforming FIB-4 + Fibroscan. Notably, 74% of F3–F4 patients had FIB-4 scores below 2.67, showing LIVERFASt’s value in addressing the limitations of indeterminate zones in traditional scoring.