Opinion Review
Copyright ©The Author(s) 2020.
World J Gastroenterol. Jul 7, 2020; 26(25): 3528-3541
Published online Jul 7, 2020. doi: 10.3748/wjg.v26.i25.3528
Table 2 Key diagnostic modalities for nonalcoholic fatty liver disease and nonalcoholic steatohepatitis[11,35,85,86]
Diagnostic TestsAdvantagesLimitations
Liver enzymes and other blood tests for fibrosis
Platelet count; APRI; AST; ALT; AST/ALT ratio; Hyaluronic acid; ELF; Hepascore; FibroSpect; FibroTest/FibroSureSimple and easy; AST/ALT of > 1 is predictive of fibrosis; ELF can predict stage of fibrosis and outcomesAST and ALT can be normal in some patients with NAFLD; ELF is not widely available; Some tests initially developed for HCV; Limited published data on external validation
Radiology
UltrasonographyEasily available; Safe; Overall scanning of abdominal organsCannot detect mild degree of steatosis (< 30% of hepatocytes); Does not distinguish between steatosis and NASH; Operator dependent
MRIMore sensitive than ultrasonographyCost and availability; Does not distinguish between steatosis and NASH
Transient; ElastographyCan detect fibrosisCost and availability
MRECan detect fibrosis and MRI-PDFF can quantify steatosisCost and availability
Fibrosis scoring systems
NAFLD fibrosis score (NFS), Fibro Meter Fibrosis-4 (FIB-4)Allow a more targeted use of liver biopsy by reliably excluding advanced fibrosis in a high proportion of NAFLD patients; Potentially predict liver-related and cardiovascular complications and deathSignificant number with indeterminate scores; Limited external validation in NASH
Liver biopsyGold standard for diagnosis of NAFLD and NASH; Allows staging of the diseaseInvasive; Associated with complications – pain, intraperitoneal bleeding; Cost