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Cited by 39Liver Disease Diagnosis and TreatmentLiver Disease and TransplantationLiver Diseases and Immunity

Non-invasive diagnosis and staging of non-alcoholic fatty liver disease

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Kechagias, Stergios, Ekstedt, Mattias, Simonsson, Christian, Nasr, Patrik·2022·Hormones
DOI 10.1007/s42000-022-00377-8PMC PMC9464753
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Abstract

Non-alcoholic fatty liver disease (NAFLD) is considered to be the hepatic manifestation of the metabolic syndrome and is characterized by ectopic accumulation of triglycerides in the cytoplasm of hepatocytes, i.e., steatosis. NAFLD has become the most common chronic liver disease, with an estimated global prevalence of 25%. Although the majority of NAFLD patients will never experience liver-related complications, the progressive potential of NAFLD is indisputable, with 5–10% of subjects progressing to cirrhosis, end-stage liver disease, or hepatocellular carcinoma. NAFLD patients with advanced fibrosis are at the highest risk of developing cardiovascular and cirrhosis-related complications. Liver biopsy has hitherto been considered the reference method for evaluation of hepatic steatosis and fibrosis stage. Given the limitations of biopsy for widescale screening, non-invasive tests (NITs) for assessment of steatosis and fibrosis stage, including serum-based algorithms and ultrasound- and magnetic resonance-based methods, will play an increasing role in the management of NAFLD patients. This comprehensive review presents the advantages and limitations of NITs for identification of steatosis and advanced fibrosis in NAFLD. The clinical implications of using NITs to identify and manage NAFLD patients are also discussed.

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  • Imaging techniques are not ideal for mass screening due to significant drawbacks including high cost, lack of safety, lack of consensus, limited accessibility, and complexity.

    “However, these methods are usually used for disease diagnosis and are not ideal for mass screening due to significant drawbacks, including high cost (CT and MRI scans), lack of safety (CT scans), lack of consensus (biomarker-based indices), limited accessibility (transient elastography, MRI scans), and complexity (MRI scans) [41, 42].”

    From Effectiveness of body roundness index for the prediction of nonalcoholic fatty liver disease: a systematic review and meta-analysis (2025) · cites this paper as [42]

    The Steatosis sections on computed tomography and magnetic resonance techniques (pages not provided) support CT radiation exposure and MRI’s cost, limited availability, and time demands. The serum-biomarker section says no algorithm can yet be recommended as an initial NAFLD screening tool. The copy does not identify high CT cost as a drawback, and the Clinical implications section calls VCTE the most widely available liver-stiffness measurement device, rather than describing it as having limited accessibility. (LLM, conf=0.87)

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Cited by

Sorted by citations

Authors
Kechagias, S., Ekstedt, M., Simonsson, C., & Nasr, P.
Affiliations
Linköping University (SE)
Corresponding author
Kechagias, Stergios
ORCID
Venue
Hormones
Publisher
Springer Science and Business Media LLC
Published
2022-06-04
Volume
21
Issue
3
Pages
349-368
ISSN
  • 1109-3099 (ISSN-L)
  • 2520-8721
DOI
10.1007/s42000-022-00377-8
PMC
PMC9464753
OpenAlex
W4281844648
Cited by
39
References
13
Citations by year
2026: 9 · 2025: 8 · 2024: 7 · 2023: 13 · 2022: 2
FWCI
1.19
Type
journal article
Language
en
Open access
Licence
Locations
  • HORMONES (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Diva portal (Dalarna University Library) (submittedVersion, other-oa)
Funders
Linköping University
Topics
  • Health Sciences › Medicine › Epidemiology › Liver Disease Diagnosis and Treatment
  • Health Sciences › Medicine › Hepatology › Liver Disease and Transplantation
  • Health Sciences › Medicine › Hepatology › Liver Diseases and Immunity
Keywords
non-alcoholic fatty liver disease, non-invasive diagnosis, fibrosis staging, hepatic steatosis, metabolic syndrome, liver biopsy limitations, ultrasound elastography, magnetic resonance elastography, NAFLD screening, cirrhosis progression, cardiovascular risk
MeSH terms
Biopsy, Fibrosis, Humans, Liver, Liver Cirrhosis, Liver Neoplasms, Non-alcoholic Fatty Liver Disease

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