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At BILM, we believe in the power of Educating, Accrediting and inspiring Excellence in Longevity Medicine for doctors in the UK.

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1. Scope

Covered:

  • Imaging used to detect subclinical disease and stratify risk in largely asymptomatic adults: coronary artery calcium (CAC) scoring, coronary CT angiography (CCTA), carotid ultrasound, dual-energy X-ray absorptiometry (DXA/DEXA) for bone density and body composition, hepatic imaging (ultrasound, controlled attenuation parameter [CAP]/transient elastography [TE], MRI-PDFF, MR elastography), visceral/ectopic fat quantification, and whole-body MRI (WB-MRI).
  • Imaging-derived “biological age” constructs (research concept).
  • Practical selection, work-up, monitoring, harms, and management scenarios.

Not covered: Diagnostic imaging in symptomatic patients (follow local/secondary-care pathways); population cancer-screening programmes already governed by the UK National Screening Committee (breast, bowel, cervical, targeted lung); dedicated neuro-degeneration diagnostic imaging; molecular blood/epigenetic “ageing clocks”; therapeutic (interventional) protocols.

Framing: All content is adjunctive to conventional care. Much of “longevity imaging” is used off the label of any national screening programme and rests on prognostic association rather than randomised outcome data; this is flagged throughout.

2. Background and biological rationale

  • Geroscience premise: Ageing produces progressive, subclinical structural change across organ systems long before symptoms. Imaging can quantify accumulated tissue-level damage (atherosclerotic plaque, low bone mineral density, sarcopenia, visceral/hepatic fat, white-matter change), providing a “phenotypic” readout of biological rather than chronological age (Lee et al., RadioGraphics, 2025, PMID 40608553; Forman et al., JACC, 2023).
  • Mechanisms captured by imaging (robust human correlation):
    • Vascular ageing/atherosclerosis — CAC and CCTA plaque burden reflect cumulative genetic and acquired risk and predict events (Wong, Curr Atheroscler Rep, 2022, PMID 36374366).
    • Musculoskeletal ageing — DXA bone mineral density (BMD) and appendicular lean mass index reflect osteoporosis/sarcopenia (“osteosarcopenia”), which predict fracture, disability and mortality (Pasco et al., J Cachexia Sarcopenia Muscle, 2017).
    • Ectopic/visceral adiposity and hepatic steatosis — imaging-quantified visceral adipose tissue (VAT) and liver fat correlate with insulin resistance, incident type 2 diabetes and CVD independent of BMI (Lee et al., Am J Med, 2018, PMID 29518370; Tejani et al., Mayo Clin Proc, 2022, PMID 34598789).
  • Preclinical / mechanistic-only (clearly separated — do NOT infer clinical benefit): imaging of hepatic mitochondrial function and substrate flux (multinuclear MRS, novel PET tracers), fibrogenesis-targeted molecular probes, and AI-derived “CT biological age” models remain research tools with no outcome data (Jonuscheit & Schrauwen-Hinderling, Diabetologia, 2026, PMID 42461275; Lee et al., 2025).

3. Evidence base and GRADE-style summary

Evidence for imaging that changes hard outcomes is largely confined to LDCT lung screening (RCT/meta-analysis) and CCTA in stable chest pain (RCT). For most “longevity imaging” the evidence is prognostic association (cohort) or diagnostic accuracy against a reference standard, with outcome benefit unproven. Surrogate–outcome linkage should not be over-interpreted.

Modality / outcomeBest evidenceGRADE certaintyKey limitationsStrength of recommendation
LDCT — lung-cancer mortality (high-risk ever-smokers 50–80y, ≥20 pack-years)8-RCT Cochrane meta-analysis, NLST + NELSON (Bonney, Cochrane, 2022; USPSTF, JAMA, 2021)HighOverdiagnosis ~18%, false positives, indirect to never-smokersStrong — offer to eligible high-risk; align with UK TLHC programme
CCTA — CHD death/non-fatal MI (via intensified prevention)SCOT-HEART 10-yr RCT, HR 0.79 (Williams, Lancet, 2025, PMID 39863372)ModeratePopulation = symptomatic stable chest pain (indirect to asymptomatic screening)Conditional in symptomatic pathway; research/insufficient as asymptomatic screen
CAC — ASCVD risk reclassificationLarge cohorts/registries; guideline-endorsed (Wong 2022; AHA/ACC, 2026)Moderate (prognosis)No RCT proving event reduction from screening; DK trial (CAC+ABI) neutral for all-cause deathConditional — consider to refine statin decisions at borderline/intermediate risk
CAC — reducing CV events by screeningDanish screening RCT neutral (Zaman, Lancet Commission, 2025)LowImprecision; single populationOnly in research as a stand-alone outcome claim
DXA BMD — fracture predictionLarge cohorts + FRAX (Gonera-Furman, J Clin Med, 2022)Moderate–HighSurrogate; treatment benefit established separatelyStrong — offer where fracture-risk assessment indicated
DXA lean mass / body composition — mortality/disabilityProspective cohorts (Pasco 2017; Shimada, 2023)Low–ModerateInconsistent for lean mass alone; no cut-off consensusConditional — consider for sarcopenia phenotyping
Hepatic imaging (CAP/TE, MRI-PDFF, MRE) — steatosis/fibrosis detectionAASLD guideline; accuracy studies (Sterling, AASLD, 2025; Nogami, 2022)Moderate–High (diagnostic accuracy)Surrogate for outcomes; MRI cost/accessConditional — consider in cardiometabolic risk
VAT / liver-fat quantification — cardiometabolic riskFramingham, Dallas Heart, UK Biobank cohorts (Lee 2018; Tejani 2022)Moderate (association)Causality uncertain (MR neutral for isolated liver fat); no intervention RCTConditional — consider for phenotyping, not routine
Whole-body MRI — cancer detection / mortality in average-risk adultsSystematic reviews/meta-analyses (Kwee 2019; Gibson, BMJ, 2018; Martins da Fonseca, 2026)Very lowCancer yield ~1–2%; incidental findings 12–32%; no mortality/cost-effectiveness dataRecommend against routine use / only in research or defined high-risk syndromes
Imaging “biological age” (CT/MRI AI models)Emerging descriptive studies (Lee 2025; Puig, 2020)Very lowNo prospective validation, no outcome/actionability dataOnly in research

GRADE domains applied above: study limitations (most non-RCT), inconsistency (heterogeneous protocols/cut-offs, high I² in WB-MRI reviews), indirectness (symptomatic → asymptomatic; surrogate → hard outcome), imprecision (small/underpowered screening RCTs), and publication bias (commercial WB-MRI literature dominated by moderate/serious risk-of-bias studies).

4. Patient selection and indications

General principle: target imaging to a pre-test probability high enough to change management, and prefer modality with proven outcome benefit or established guideline cut-offs.

Who may benefit (consider):

  • CAC: asymptomatic adults ~40–75y at borderline–intermediate estimated ASCVD risk, or with clinician/patient uncertainty about statin initiation; family history of premature CVD (Wong 2022; AHA/ACC, 2026). Limited utility <40y.
  • CCTA: patients with symptoms of stable angina (guideline-based, e.g. NICE CG95 pathway) — not established as an asymptomatic screen.
  • LDCT: ever-smokers 50–80y with ≥20 pack-years, smoking within 15y (USPSTF, 2021; UK Targeted Lung Health Check).
  • DXA (BMD): postmenopausal women/men ≥50y with clinical risk factors, or FRAX indicating assessment; body-composition DXA where sarcopenia/osteosarcopenia is clinically suspected.
  • Hepatic imaging (CAP/TE ± MRI-PDFF): adults with type 2 diabetes, obesity/metabolic syndrome, or persistently abnormal LFTs (MASLD case-finding).
  • VAT quantification: research/phenotyping in metabolically-at-risk adults; not routine.

Clinical-scenario mapping:

  • Middle-aged, high cardiometabolic risk: CAC + hepatic steatosis/fibrosis assessment offer the best evidence-to-yield ratio.
  • Older adult with frailty/multimorbidity: DXA (bone + lean mass) most actionable; avoid low-yield WB-MRI/CT with high incidental-finding burden.
  • Athletic individual seeking “optimisation”: counsel that most imaging cannot demonstrate healthspan benefit; body composition and CAC may inform, WB-MRI generally not indicated.

Exclusion / high-risk groups:

  • Pregnancy (avoid ionising imaging unless essential).
  • High anxiety/low tolerance of uncertainty (incidentalomas may cause net harm).
  • Limited life expectancy or where findings would not alter management.
  • Contrast agents: renal impairment (iodinated CT contrast), gadolinium caution in severe renal impairment.

Regulatory/ethical status:

  • On-label / programme-aligned: LDCT (targeted high-risk), DXA for osteoporosis, hepatic NITs within MASLD pathways.
  • Off-label / outside national screening: CAC and CCTA as screening in asymptomatic people, WB-MRI for average-risk cancer screening, VAT/”biological-age” imaging.
  • Only in research / trial or registry frameworks: imaging biological-age models, molecular/functional research MRI/PET, average-risk WB-MRI.
  • All non-programme imaging should proceed only as adjunctive care with documented informed consent covering incidental findings, radiation, cost and unproven benefit.

5. Assessment and baseline work-up

Pre-imaging assessment:

  • History: cardiometabolic risk factors, smoking/pack-years, family history of premature CVD/cancer, fracture history, alcohol, medications.
  • Examination: BP, weight/height/waist circumference, BMI.
  • Validated tools: QRISK3 (UK ASCVD risk), FRAX (fracture), FIB-4 (first-line liver fibrosis), lung-cancer risk model (e.g. PLCOm2012) for LDCT eligibility.

Baseline investigations to accompany imaging:

  • Bloods: lipid profile (incl. Lp(a) once), HbA1c/fasting glucose, LFTs, renal function (pre-contrast), FBC, TFTs; vitamin D/calcium if bone imaging.
  • Sequenced liver pathway: FIB-4 → if indeterminate/high, TE (liver stiffness) and CAP; MRI-PDFF/MRE where quantification or fibrosis staging is needed (Sterling, AASLD, 2025).

Risk stratification (benefit vs harm):

  • Benefit likely: modifiable risk factors present and finding would trigger a proven therapy (e.g. statin after CAC ≥100).
  • Harm risk high: very low pre-test probability, radiation-sensitive/young, high anxiety, or modalities with high incidental-finding rates (WB-MRI, whole-body CT).

Baseline documentation: modality, protocol/field strength, radiation dose (mSv) where relevant, quantitative outputs (Agatston score, BMD T-score/Z-score and appendicular lean mass, liver stiffness [kPa]/CAP [dB/m]/PDFF [%], VAT area), incidental findings and agreed follow-up, and the shared-decision record.

6. Protocols and practical implementation

(Non-pharmacological; “dosing” = imaging protocol/interval.)

Supported by robust human data:

  • LDCT: non-contrast, low-dose (target effective dose <1 mSv; CTDIvol ≤3 mGy average build), volumetric nodule analysis, structured (Lung-RADS) reporting; annual rounds in eligible high-risk individuals (ESTI, Eur Radiol, 2026; NCCN, 2025).
  • CAC: non-contrast ECG-gated cardiac CT, Agatston scoring; ~0.5–1.5 mSv. Repeat scanning of a zero score generally not before ~5 years and only if it would change management (Wong 2022).
  • DXA: lumbar spine + hip BMD (T-score); total-body DXA for lean/fat mass; negligible radiation. Rescreen interval guided by baseline BMD and risk (typically 2 years, longer if normal).
  • Hepatic NITs: TE with CAP (steatosis rule-out CAP ~263–275 dB/m; fibrosis LSM cut-offs ~8 kPa [≥F2] to ~12–12.5 kPa [≥F3]); MRI-PDFF (≥5.7% rules in steatosis) and MRE for accurate fibrosis staging/treatment monitoring (Sterling, AASLD, 2025; Zannad, JACC, 2026).

Extrapolated / use with caution (early-phase or association-only):

  • CCTA as asymptomatic screen: iodinated contrast, ~1–5 mSv; AI plaque staging under investigation — outcome benefit in asymptomatic people not established (AHA/ACC, 2026).
  • WB-MRI: no ionising radiation but no standardised screening protocol; ONCO-RADS reporting reduces but does not eliminate overcall (Padhani, 2026).
  • VAT quantification / imaging biological-age: research protocols only; no validated action thresholds.

7. Monitoring, safety and follow-up

Monitoring plan (integrate imaging into a management loop, not stand-alone):

  • CAC → if elevated, initiate/intensify statin and risk-factor control; repeat imaging rarely needed to monitor therapy.
  • Liver NITs → serial TE/MRI-PDFF to track MASLD response to weight loss/pharmacotherapy.
  • DXA → interval BMD to monitor osteoporosis treatment; lean mass to track sarcopenia interventions.
  • LDCT → structured annual surveillance with nodule-management protocol.

Suggested intervals: short-term (weeks–3 months) only for indeterminate findings requiring characterisation; medium-term (1 year) for LDCT rounds and liver-fat response; long-term (2–5 years) for CAC/DXA where clinically justified.

Harms / adverse-effect profile (the principal “safety” issue in screening imaging):

  • Incidental findings (“incidentalomas”): WB-MRI potentially serious incidental findings pooled ~3.9% (brain+body), and any critical/indeterminate findings 12–32%, with substantial false positives and cascade testing (Gibson, BMJ, 2018, PMID 30467245; Kwee & Kwee, 2019). Confirmed cancer yield only ~1–2% (Martins da Fonseca, Eur Radiol, 2026).
  • False positives / overdiagnosis: LDCT overdiagnosis ~18%; ~1 in 7 screened have an abnormality, ~90% not cancer; a minority undergo invasive procedures (Bonney, Cochrane, 2022; USPSTF, 2021).
  • Radiation: single LDCT ~0.65–2.4 mSv; whole-body/abdomen-pelvis CT considerably higher. Population modelling projects meaningful aggregate radiation-induced cancer from current CT volumes (Smith-Bindman, JAMA Intern Med, 2025, PMID 40126522); risk highest per-mSv in younger/female patients. MRI/DXA avoid ionising radiation.
  • Psychological: short-term anxiety common; longer-term psychological harm appears limited in some cohorts but data are weak (Conti, 2025).
  • Contrast: iodinated contrast (allergy, nephrotoxicity); gadolinium (caution in severe renal impairment).

Required actions for abnormal findings: apply structured reporting (Lung-RADS, ONCO-RADS, CAD-RADS) and pre-agreed escalation pathways; refer suspicious findings into NHS secondary care; avoid reflexive further imaging for low-probability incidentalomas.

Interactions: cumulative radiation across multiple CT-based “packages” — track lifetime dose. Comorbidity interactions: renal impairment (contrast), claustrophobia/implants (MRI), body habitus (ultrasound/TE reliability, mitigated by MRI-PDFF).

Special populations: avoid ionising imaging in pregnancy; in frailty/extreme age prioritise DXA and only image where a finding would change management; renal/hepatic impairment — modality/contrast adjustments as above.

8. Contraindications and cautions

Absolute:

  • Pregnancy — ionising imaging unless essential.
  • MRI with incompatible implants/devices; severe uncontrolled claustrophobia (MRI/WB-MRI).
  • Known severe iodinated-contrast anaphylaxis (contrast CT).

Relative / specialist input advised:

  • Significant renal impairment (contrast agents).
  • High health anxiety or inability to tolerate diagnostic uncertainty.
  • Young age / high cumulative prior radiation.
  • Limited life expectancy or where results will not change management.

Harm likely to outweigh benefit with current evidence:

  • Routine average-risk whole-body MRI or whole-body CT for “longevity screening” — low yield, high incidental-finding/false-positive burden, no demonstrated mortality or cost-effectiveness benefit.
  • CAC/CCTA in very low-risk adults <40y — poor discrimination, potential false reassurance (a CAC of 0 does not exclude risk in smokers, diabetes, or strong family history).

9. Practical management scenarios

Scenario A — Middle-aged adult, multiple cardiometabolic risk factors

Recommendation: Consider CAC scoring and hepatic steatosis/fibrosis assessment (Conditional). Do not offer routine WB-MRI.

  1. Assessment: QRISK3, lipids incl. one-off Lp(a), HbA1c, LFTs, FIB-4, waist circumference.
  2. Shared decision/consent: explain CAC refines statin decisions but has no RCT proving event reduction; cover radiation and incidental findings.
  3. Initiation: CAC (non-contrast gated CT); if borderline liver risk, TE+CAP → MRI-PDFF/MRE if indeterminate.
  4. Monitoring: CAC ≥100 → start/intensify statin + risk-factor control; MASLD → lifestyle ± therapy with serial NITs.
  5. Escalate/stop: obstructive disease features or symptoms → cardiology; advanced fibrosis (e.g. LSM ≥12 kPa) → hepatology.

Scenario B — Older, frail adult with multimorbidity

Recommendation: Restrict imaging to high-yield, low-harm tests; avoid WB-MRI/whole-body CT (Recommend against). Offer DXA where it changes management.

  1. Assessment: frailty/functional status, falls, FRAX, nutrition.
  2. Consent: emphasise avoidance of low-yield imaging and incidental-finding cascades.
  3. Initiation: DXA (bone + lean mass); TE only if liver management would change.
  4. Monitoring: treat osteoporosis/osteosarcopenia (resistance exercise, protein, bone therapy); reassess BMD per treatment guidance.
  5. Escalate/stop: fragility fracture or rapid functional decline → geriatrics/falls service.

Scenario C — Patient already under specialist care (adjunctive use)

Recommendation: Consider imaging only to complement, not duplicate, the specialist plan; coordinate to avoid repeated radiation.

  1. Assessment: review existing imaging/results with consent; identify genuine gaps.
  2. Consent: clarify adjunctive, non-programme status.
  3. Initiation: add only management-changing tests (e.g. MRI-PDFF to monitor MASLD therapy).
  4. Monitoring: share results with the treating specialist and GP; maintain a single cumulative-dose record.
  5. Escalate/stop: any new suspicious finding → refer into the relevant NHS pathway rather than parallel private work-up.

High-risk hereditary exception: in confirmed Li-Fraumeni syndrome, annual WB-MRI is guideline-endorsed surveillance (NCCN, 2026) — a distinct high-risk indication, not average-risk screening.

10. Research gaps and future directions

  • Outcome evidence: no RCT shows that CAC, CCTA, WB-MRI or DXA screening in asymptomatic adults reduces mortality/morbidity; asymptomatic CCTA and AI plaque-staging RCTs are ongoing.
  • Surrogate-to-outcome linkage: whether improving imaging surrogates (VAT, liver fat, “imaging biological age”) yields hard clinical benefit is unproven.
  • Standardisation: WB-MRI protocols, reporting and incidental-finding management need harmonisation and long-term negative-predictive-value data.
  • Cost-effectiveness and net harm: incidental-finding cascades, overdiagnosis and cumulative radiation require formal evaluation before routine adoption.
  • Priority questions: optimal CAC re-scan intervals; value of adding imaging to QRISK3/FRAX for reclassification and outcomes; validated action thresholds for body-composition and imaging biological-age models.
  • Recommended posture: average-risk WB-MRI, imaging biological-age tools and functional/molecular research imaging should be confined to well-designed trials or registries with prospective outcome capture.

Footnote

The summary is deliberately conservative about the evidence hierarchy. The only imaging with high-certainty outcome evidence is LDCT lung screening in high-risk ever-smokers, where meta-analysis and the NLST/NELSON RCTs show a ~21% relative reduction in lung-cancer mortality, offset by ~18% overdiagnosis and frequent false positives.[1][2][14] CCTA carries moderate-certainty RCT outcome data but only in symptomatic stable chest pain (SCOT-HEART 10-year HR 0.79 for CHD death/non-fatal MI, driven by intensified prevention), so it is indirect evidence for asymptomatic longevity screening.[3][15] CAC is a strong prognostic marker and is guideline-endorsed to refine statin decisions, but no RCT demonstrates that CAC screening reduces events, and a Danish screening RCT was neutral.[4][5][6] DXA, hepatic NITs, and VAT/liver-fat imaging rest on diagnostic-accuracy or cohort-association data and surrogate endpoints.[11][12][10][16][17] Whole-body MRI for average-risk adults is flagged as recommend-against/research-only given ~1–2% cancer yield, 12–32% incidental-finding rates, and no mortality or cost-effectiveness data, with the Li-Fraumeni high-risk exception noted.[7][8][9][18] Radiation harms from cumulative CT are quantified per current modelling.[13]

Two points to verify against local practice: UK-specific pathways (QRISK3, FRAX, NICE CG95, the Targeted Lung Health Check) should govern programme-aligned imaging, and all non-programme imaging requires documented informed consent covering incidental findings, radiation and unproven benefit. 

Figure 1 Association of CAC Score With Survival Verma KP, Inouye M, Meikle PJ, et al. New Cardiovascular Risk Assessment Techniques for Primary Prevention: JACC Review Topic of the Week. Journal of the American College of Cardiology. 2022;80(4):373-387. doi:10.1016/j.jacc.2022.05.015.

Figure 1 Figure 1. Kwiecinski J, Tzolos E, Williams MC, et al. Noninvasive Coronary Atherosclerotic Plaque Imaging. JACC. Cardiovascular Imaging. 2023;16(12):1608-1622. doi:10.1016/j.jcmg.2023.08.021.

Figure 4 Lung cancer mortality ‐ Planned time points ‐ Sensitivity analysis Bonney A, Malouf R, Marchal C, et al. Impact of Low-Dose Computed Tomography (LDCT) Screening on Lung Cancer-Related Mortality. The Cochrane Database of Systematic Reviews. 2022;8:CD013829. doi:10.1002/14651858.CD013829.pub2.

Figure 1.5 Comparison 1: Primary outcome: lung cancer‐related mortality, Outcome 5: Lung cancer‐related mortality – by time postscreening cessation (including unplanned time points) Bonney A, Malouf R, Marchal C, et al. Impact of Low-Dose Computed Tomography (LDCT) Screening on Lung Cancer-Related Mortality. The Cochrane Database of Systematic Reviews. 2022;8:CD013829. doi:10.1002/14651858.CD013829.pub2.

Figure 2 Cumulative Incidence of Death from Coronary Heart Disease or Nonfatal Myocardial Infarction. SCOT-HEART Investigators, Newby DE, Adamson PD, et al. Coronary CT Angiography and 5-Year Risk of Myocardial Infarction. The New England Journal of Medicine. 2018;379(10):924-933. doi:10.1056/NEJMoa1805971.

Figure 3 Subgroup Analyses for the Primary End Point of Death from Coronary Heart Disease or Nonfatal Myocardial Infarction at 5 Years. SCOT-HEART Investigators, Newby DE, Adamson PD, et al. Coronary CT Angiography and 5-Year Risk of Myocardial Infarction. The New England Journal of Medicine. 2018;379(10):924-933. doi:10.1056/NEJMoa1805971.

Figure 1 Risk stratification algorithm proposed by Yip et al. Alkhouri N, Chalasani N, Younossi Z, et al. Review Article: An Update on Non-Invasive Tests for Steatotic Liver Disease – Insights From the ESSENCE Phase 3 Trial and Longitudinal Studies. Alimentary Pharmacology & Therapeutics. 2026;63(10):1360-1368. doi:10.1111/apt.70639.

Figure 5 Different two‐step screening strategies for MASH identification in MASLD population. Marti-Aguado D, Arnouk J, Liang JX, et al. Development and Validation of an Image Biomarker to Identify Metabolic Dysfunction Associated Steatohepatitis: MR-MASH Score. Liver International : Official Journal of the International Association for the Study of the Liver. 2024;44(1):202-213. doi:10.1111/liv.15766.

References

  1. Impact of Low-Dose Computed Tomography (LDCT) Screening on Lung Cancer-Related Mortality. Bonney A, Malouf R, Marchal C, et al. The Cochrane Database of Systematic Reviews. 2022;8:CD013829. doi:10.1002/14651858.CD013829.pub2.
  2. Screening for Lung Cancer. US Preventive Services Task Force, Krist AH, Davidson KW, et al. JAMA. 2021;325(10):962-970. doi:10.1001/jama.2021.1117.
  3. Coronary CT Angiography-Guided Management of Patients With Stable Chest Pain: 10-Year Outcomes From the SCOT-HEART Randomised Controlled Trial in Scotland. Williams MC, Wereski R, Tuck C, et al. Lancet (London, England). 2025;405(10475):329-337. doi:10.1016/S0140-6736(24)02679-5.
  4. Evolution of Coronary Calcium Screening for Assessment of Atherosclerotic Cardiovascular Disease Risk and Role in Preventive Cardiology. Wong ND. Current Atherosclerosis Reports. 2022;24(12):949-957. doi:10.1007/s11883-022-01073-z.
  5. The Lancet Commission on Rethinking Coronary Artery Disease: Moving From Ischaemia to Atheroma. Zaman S, Wasfy JH, Kapil V, et al. Lancet (London, England). 2025;405(10486):1264-1312. doi:10.1016/S0140-6736(25)00055-8.
  6. Use of Predicted Risk and Expected Benefit to Guide Decision-Making in Cardiovascular-Kidney-Metabolic Syndrome for the Primary Prevention of Cardiovascular Disease: A Scientific Statement From the American Heart Association and American College of Cardiology. Khan SS, Bhave N, Blumenthal RS, et al. Circulation. 2026;154(4):e159-e180. doi:10.1161/CIR.0000000000001447.
  7. Potentially Serious Incidental Findings on Brain and Body Magnetic Resonance Imaging of Apparently Asymptomatic Adults: Systematic Review and Meta-Analysis. Gibson LM, Paul L, Chappell FM, et al. BMJ (Clinical Research Ed.). 2018;363:k4577. doi:10.1136/bmj.k4577.
  8. Whole-Body MRI for Opportunistic Cancer Detection in Asymptomatic Individuals: A Systematic Review and Meta-Analysis. Martins da Fonseca J, Trennepohl T, Pinheiro LG, et al. European Radiology. 2026;36(3):1813-1823. doi:10.1007/s00330-025-11976-5.
  9. Whole-Body MRI for Preventive Health Screening: A Systematic Review of the Literature. Kwee RM, Kwee TC. Journal of Magnetic Resonance Imaging : JMRI. 2019;50(5):1489-1503. doi:10.1002/jmri.26736.
  10. AASLD Practice Guideline on Imaging-Based Noninvasive Liver Disease Assessment of Hepatic Fibrosis and Steatosis. Sterling RK, Duarte-Rojo A, Patel K, et al. Hepatology (Baltimore, Md.). 2025;81(2):672-724. doi:10.1097/HEP.0000000000000843.
  11. Musculoskeletal decline and mortality: prospective data from the Geelong Osteoporosis Study. Pasco JA, Mohebbi M, Holloway KL, et al. Journal of Cachexia, Sarcopenia and Muscle. 2017;8(3):482-489. doi:10.1002/jcsm.12177.
  12. Osteosarcopenia-the Role of Dual-Energy X-Ray Absorptiometry (DXA) in Diagnostics. Gonera-Furman A, Bolanowski M, Jędrzejuk D. Journal of Clinical Medicine. 2022;11(9):2522. doi:10.3390/jcm11092522.
  13. Projected Lifetime Cancer Risks From Current Computed Tomography Imaging. Smith-Bindman R, Chu PW, Azman Firdaus H, et al. JAMA Internal Medicine. 2025;185(6):710-719. doi:10.1001/jamainternmed.2025.0505.
  14. ESR Essentials: Lung Cancer Screening With Low-Dose CT-practice Recommendations by the European Society of Thoracic Imaging. Revel MP, Biederer J, Nair A, et al. European Radiology. 2026;36(3):2064-2073. doi:10.1007/s00330-025-11910-9.
  15. Coronary CT Angiography and 5-Year Risk of Myocardial Infarction. SCOT-HEART Investigators, Newby DE, Adamson PD, et al. The New England Journal of Medicine. 2018;379(10):924-933. doi:10.1056/NEJMoa1805971.
  16. Cardiometabolic Health Outcomes Associated With Discordant Visceral and Liver Fat Phenotypes: Insights From the Dallas Heart Study and UK Biobank. Tejani S, McCoy C, Ayers CR, et al. Mayo Clinic Proceedings. 2022;97(2):225-237. doi:10.1016/j.mayocp.2021.08.021.
  17. Visceral and Intrahepatic Fat Are Associated With Cardiometabolic Risk Factors Above Other Ectopic Fat Depots: The Framingham Heart Study. Lee JJ, Pedley A, Hoffmann U, et al. The American Journal of Medicine. 2018;131(6):684-692.e12. doi:10.1016/j.amjmed.2018.02.002.
  18. Genetic/Familial High-Risk Assessment: Breast, Ovarian, Pancreatic, and Prostate. National Comprehensive Cancer Network. Updated 2026-02-19.
  19. New Cardiovascular Risk Assessment Techniques for Primary Prevention: JACC Review Topic of the Week. Verma KP, Inouye M, Meikle PJ, et al. Journal of the American College of Cardiology. 2022;80(4):373-387. doi:10.1016/j.jacc.2022.05.015.
  20. Noninvasive Coronary Atherosclerotic Plaque Imaging. Kwiecinski J, Tzolos E, Williams MC, et al. JACC. Cardiovascular Imaging. 2023;16(12):1608-1622. doi:10.1016/j.jcmg.2023.08.021.
  21. Review Article: An Update on Non‐Invasive Tests for Steatotic Liver Disease ‐ Insights From the ESSENCE Phase 3 Trial and Longitudinal Studies. Alkhouri N, Chalasani N, Younossi Z, et al. Alimentary Pharmacology & Therapeutics. 2026;63(10):1360-1368. doi:10.1111/apt.70639.
  22. Development and validation of an image biomarker to identify metabolic dysfunction associated steatohepatitis: MR–MASH score. Marti-Aguado D, Arnouk J, Liang JX, et al. Liver International : Official Journal of the International Association for the Study of the Liver. 2024;44(1):202-213. doi:10.1111/liv.15766.