Non-invasive tests of non-alcoholic fatty liver disease

Abstract

For the detection of steatosis, quantitative ultrasound imaging techniques have achieved great progress in past years. Magnetic resonance imaging proton density fat fraction is currently the most accurate test to detect hepatic steatosis. Some blood biomarkers correlate with non-alcoholic steatohepatitis, but the accuracy is modest. Regarding liver fibrosis, liver stiffness measurement by transient elastography (TE) has high accuracy and is widely used across the world. Magnetic resonance elastography is marginally better than TE but is limited by its cost and availability. Several blood biomarkers of fibrosis have been used in clinical trials and hold promise for selecting patients for treatment and monitoring treatment response. This article reviews new developments in the non-invasive assessment of non-alcoholic fatty liver disease (NAFLD). Accumulating evidence suggests that various non-invasive tests can be used to diagnose NAFLD, assess its severity, and predict the prognosis. Further studies are needed to determine the role of the tests as monitoring tools. We cannot overemphasize the importance of context in selecting appropriate tests.

The Coexistence of Nonalcoholic Fatty Liver Disease and Type 2 Diabetes Mellitus

“…Accuracy is presented as AUC (area under the receiver-operating characteristics curve) value. The figure does not include liver biopsy, which remains the gold standard procedure for the diagnosis of nonalcoholic steatohepatitis (NASH) and staging of nonalcoholic fatty liver disease (NAFLD) [ 139 ].…”

Diagnostic scores and scales for appraising Nonalcoholic fatty liver disease and omics perspectives for precision medicine

“…Liver fibrosis is the most important factor prognostic determinates in patients with NAFLD, being the noninvasive assessment of fibrosis severity essential in the management of this disease [40,41]. The scores designed are usually a direct measure of fibrosis or fibrinolysis (Table 3) and have been validated extensively to differentiate patients with significant fibrosis (F2 to F4) vs. those without significant fibrosis (F0 to F1) as reviewed elsewhere [10].…”

“…Other models such as the Fibromax, which combines five components into one algorithm, is considered an accurate score for liver fibrosis [44]. Also, the Fibrometer and the FibroTest have demonstrated a good diagnostic performance for advanced fibrosis, even if their cost and availability have limited their used in clinical practice [10,17 ▪▪ ].…”

“…Liver biopsy is currently the reference for the diagnosis of MAFLD/NAFLD [10]. However, due to the practical and safety limitations of liver biopsy there is an urgent and growing interest in the development of alternative methods for the diagnosis of NAFLD [16].…”

Metabolic dysfunction-associated fatty liver disease: from basic research to clinical application

“…In a recent issue of CMJ , Li et al review new developments in non-invasive testing for NAFLD, with respect to steatosis, steatohepatitis, and fibrosis. [ 16 ] For the identification of steatosis, ultrasonography remains the most common method, because of its wide availability and low cost, but magnetic resonance imaging-proton density fat fraction is currently the most accurate means of identifying hepatic steatosis, and transient elastography (TE) represents a promising technique for the evaluation of hepatic steatosis and fibrosis. Except for the widely used controlled attenuation parameter, ultrasonographic attenuation has been reported to have a low failure rate and shows moderate-to-high performance for the discrimination of degrees of steatosis in patients with chronic liver disease.…”