Noninvasive diagnosis of nonalcoholic fatty liver disease: Are we there yet?

Abstract

Nonalcoholic fatty liver disease (NAFLD) has rapidly become the most common form of chronic liver disease in the United States affecting approximately 80-100 million Americans. NAFLD includes a spectrum of diseases ranging from nonalcoholic fatty liver (NAFL) to nonalcoholic steatohepatitis (NASH) to fibrosis and eventually cirrhosis. Patients with NASH and significant fibrosis on liver biopsy have an increased risk for liver-related morbidity and mortality compared to those with NAFL. Due to the high prevalence of NAFLD and its progressive nature, there has been an urgent need to develop reliable noninvasive tests that can accurately predict the presence of advanced disease without the need for liver biopsy. These tests can be divided into those that predict the presence of NASH and those that predict the presence of fibrosis. In this review, we provide a concise overview of different noninvasive methods for staging the severity of NAFLD.

Keywords: Biomarkers; Fibrosis; NASH.

Conflict of interest statement

Conflict of Interest: AEF reports that he is named as co-inventor on pending and issued patents filed by the Cleveland Clinic and UCSD that refer to the use of biomarkers in fatty liver disorders. NA has no conflict of interest.

Copyright © 2016 Elsevier Inc. All rights reserved.

Figures

Figure 1. Different Imaging Studies for Liver Fibrosis in Patients with NAFLD

VCTE, Vibration controlled transient elastography; MRE, Magnetic resonance elastography; ARFI, Acoustic radiation force impulse.

Figure 2. Algorithm to Diagnose Advanced Fibrosis in NAFLD

The algorithm is based on using the combination of liver stiffness measurement (LSM) by vibration controlled transient elastography (VCTE) plus the NAFLD fibrosis score (NFS). Having concordant low values for both LSM and NFS indicates the absence of advanced fibrosis and both tests can be repeated in 2–3 years. Having concordant high values for both tests indicates the presence of advanced fibrosis and the need to screen for cirrhosis complications including hepatocellular carcinoma and varices. Having discordant results indicates the need for liver biopsy to determine the fibrosis stage.