Home Health Benefits and limitations of non-invasive tests for the diagnosis of non-alcoholic fatty liver disease

Benefits and limitations of non-invasive tests for the diagnosis of non-alcoholic fatty liver disease

Benefits and limitations of non-invasive tests for the diagnosis of non-alcoholic fatty liver disease

Non-alcoholic fatty liver disease (NAFLD) is one of the most prevalent chronic liver disorders worldwide and can sometimes lead to serious conditions such as cirrhosis and hepatocellular carcinoma. Thus, early assessment of the severity of NAFLD is essential for timely intervention. Non-alcoholic steatohepatitis (NASH) and liver fibrosis are two important factors that determine the likelihood of progression to NAFLD and the development of cirrhosis, respectively. Until now, liver biopsy has been the most widely recognized method for the diagnosis and evaluation of NASH and fibrosis. However, it is an invasive process that is susceptible to observer bias and sub-standardisation.

Consequently, recent studies have focused on exploring non-invasive tests for NAFLD, NASH and fibrosis for clinical applications. Now, researchers in China have collated recent developments in NAFLD assessment and analyzed the benefits and limitations of the new methods in a review made available online in January 2022 and later in Volume 135, Issue 5, on March 5, 2022. has been published. Chinese Medical Journal,

Accumulating evidence scores in various non-invasive tests to diagnose NAFLD, assess its severity, and predict its prognosis. We reviewed the recent literature and summarized the key features of each trial.,

Prof. Vincent Wai-Sun Wong, corresponding author of the study

The team clarifies that there are two major types of non-invasive tests—blood-based biomarker tests, and imaging methods. Blood-based tests, along with multi-biomarker panels, can measure and evaluate biological processes in the liver with reasonable accuracy. They may be useful for the early diagnosis of liver disorders, as they are more accessible and economical than imaging methods. For example, the Fibrosis-4 Index and the Enhanced Liver Fibrosis Panel are promising biomarker tests to detect advanced fibrosis and predict its progression. However, some of these tests are affected by age and gender and have limited efficacy in staging liver disorders.

Imaging methods have proven to be more accurate in detecting and assessing the severity of liver disorders. For example, magnetic resonance imaging proton density fat fraction detects NAFLD and NASH with high accuracy, and also stratifies NASH severity. Similarly, machine learning-based ultrasound imaging is gaining popularity to effectively detect and quantify NAFLD. Imaging techniques such as transient elastography, acoustic radiation force elastography, and magnetic resonance elastography can accurately measure liver stiffness, which is an indicator of fibrosis. However, these methods are often expensive, have limited availability, lack comprehensive validation, and may require experienced operators.

,Ultimately the selection of appropriate tests is relevant for the assessment of liver disorders. Availability, cost and local expertise are important factors when establishing a clinical care pathway for NAFLD“, observes Dr. Wong.

The authors suggest that further research is needed to determine the efficacy of these testing methods under different clinical contexts and to evaluate their importance in identifying patients in need of treatment and monitoring treatment response. A plethora of options may not always be a bad thing, however, when it comes to staying one step ahead of serious illnesses.


Journal Reference:

Lee, G., and others. (2022) Non-invasive trials of non-alcoholic fatty liver disease. Chinese Medical Journal. doi.org/10.1097/CM9.0000000000002027.