Two new MRI-based scoring strategies—single-step MPcT (MRE+PDFF+cT1) and two-step M-PcT (LSM by MRE then PDFF with cT1)—were evaluated to detect at-risk MASH. M-PcT showed superior diagnostic accuracy over FAST, MAST, and MPcT. PDFF plus cT1 also performed strongly for diagnosing active MASH and severe hepatic inflammation, outperforming FAST and MAST scores.