Noninvasive Tests for NAFLD: Where Are We Now?

Up to 30% of patients with non-alcoholic fatty liver disease (NAFLD) progress to non-alcoholic steatohepatitis (NASH), significantly increasing their risk of fibrosis and associated adverse outcomes. As such, ensuring the early identification of NAFLD and NASH in at-risk patients is a clinical priority.
PUBLISHED IN: Clinical and Molecular Hepatology (April 2023)


While it remains the gold standard to effectively diagnose NASH and hepatic steatosis, performing liver biopsies on all suspected NAFLD patients is not a feasible endeavour. Moreover, liver biopsies are significantly limited by sampling errors, inter- and intra-observer variability, and health complications owing to their invasiveness. In contrast, noninvasive tests (NITs) are spared from such risks and are easier to perform and more cost-effective than biopsies.

This editorial aimed to explore the benefits and barriers of current imaging NITs for liver steatosis.

Key learnings:

First-generation tests for the identification of steatosis include abdominal ultrasonography, computed tomography, magnetic resonance imaging, vibration-controlled transient elastography (VCTE), controlled attenuation parameter, and MRI proton density fat fraction (MRI-PDFF). These NITs may be used at disparate stages of patient stratification and management: VCTE, for instance, is commonly employed as a point-of-care test. However, when combined with magnetic resonance elastography, MRI-PDFF emerges as the most accurate NIT for the assessment of fibrosis. Importantly, second-generation tests are used to identify at-risk NASH patients, an urgent clinical priority. FAST, Agile 3+ and 4, MEFIB, and MAST scores have all been developed for this purpose. Although Agile 3+ and 4 scores’ ability to accurately predict major adverse liver outcomes makes them particularly advantageous, the MAST score by far outperforms all other MRI serum-based scores with respect to identifying at-risk NASH patients.

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S Duarte, BSc

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