Noninvasive assessment of liver disease in patients with nonalcoholic fatty liver disease
Open accessAbstract
Nonalcoholic fatty liver disease (NAFLD) is estimated to afflict approximately 1 billion individuals worldwide. In a subset of NAFLD patients, who have the progressive form of NAFLD termed nonalcoholic steatohepatitis (NASH), it can progress to advanced fibrosis, cirrhosis, hepatocellular carcinoma, and liver-related morbidity and mortality. NASH is typically characterized by a specific pattern on liver histology, including steatosis, lobular inflammation, and ballooning with or without peri-sinusoidal fibrosis. Thus, key issues in NAFLD patients are the differentiation of NASH from simple steatosis and identification of advanced hepatic fibrosis. Until now, liver biopsy has been the gold standard for identifying these 2 critical end points, but has well-known limitations, including invasiveness; rare but potentially life-threatening complications; poor acceptability; sampling variability; and cost. Furthermore, due to the epidemic proportion of individuals with NAFLD worldwide, liver biopsy evaluation is impractical, and noninvasive assessment for the diagnosis of NASH and fibrosis is needed. Although much of the work remains to be done in establishing cost-effective strategies for screening for NASH, advanced fibrosis, and cirrhosis, in this review, we summarize the current state of the noninvasive assessment of liver disease in NAFLD, and we provide an expert synthesis of how these noninvasive tools could be utilized in clinical practice. Finally, we also list the key areas of research priorities in this area to move forward clinical practice.
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Non-invasive tools perform well to rule-in and rule-out steatosis and fibrosis.
“Non-invasive tools perform well to rule-in and rule-out steatosis and fibrosis, 2”
From Muscle fat content is strongly associated with NASH: a longitudinal study in patients with morbid obesity (2021) · cites this paper as [2]
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MAFLD identifies patients with significant hepatic fibrosis better than NAFLD
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Self-citationNoninvasive assessment of liver fibrosis in NAFLD
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Castera, L., Laouenan, C., Vallet-Pichard, A., Vidal-Trécan, T., Manchon, P., Paradis, V., Roulot, D., Gault, N., Boitard, C., Terris, B., et al. (2023) · Diabetes Care · doi:10.2337/dc22-2048 · Cited by 136 · see citing works
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“LDL, mg/dL 120,5 (66,2-175,7) 117,9 (35,0-165,5) 105 (89-122) HDL, mg/dL 43 (32-65)* 42 (25-105)* 57 (42-75)”
MethodInfluentialThe Commensal Microbe V eillonella as a Marker for Response to an FGF19 Analog in NASH
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Self-citationModeling alcohol-associated liver disease in a human Liver-Chip
Nawroth, J. C., Petropolis, D. B., Manatakis, D. V., Maulana, T. I., Burchett, G., Schlünder, K., Witt, A., Shukla, A., Kodella, K., Ronxhi, J., et al. (2021) · Cell Reports · doi:10.1016/j.celrep.2021.109393 · Cited by 88 · see citing works
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Treatment Candidacy for Pharmacologic Therapies for NASH
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MRI‐Proton Density Fat Fraction Treatment Response Criteria in Nonalcoholic Steatohepatitis
Loomba, R. (2021) · Hepatology · doi:10.1002/hep.31624 · Cited by 36 · see citing works
“(3) Over the last 10 years, many noninvasive tests, both serum and imaging-based biomarkers, have been proposed to assess treatment response in NASH.”
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Patient-centered care: Key elements applicable to chronic liver disease
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Advances and Emerging Therapies in the Treatment of Non-alcoholic Steatohepatitis
Brennan, P. N., The University of Edinburgh, C. F. R. M., NHS Tayside, N. H. A. M. S., The University of Dundee, D. O. M. A. C. M., Dillon, J. F., NHS Tayside, N. H. A. M. S., The University of Dundee, D. O. M. A. C. M., McCrimmon, R., NHS Tayside, N. H. A. M. S., & The University of Dundee, D. O. M. A. C. M. (2022) · European Endocrinology · doi:10.17925/ee.2022.18.2.148 · Cited by 3 · see citing works
- Authors
- Castera, L., Friedrich-Rust, M., & Loomba, R.
- Affiliations
- University of California San Diego (US)
- Venue
- Gastroenterology
- Publisher
- Elsevier BV
- Published
- 2019-04
- Volume
- 156
- Issue
- 5
- Pages
- 1264-1281.e4
- ISSN
- 0016-5085 (ISSN-L)
- PMC
- PMC7505052
- OpenAlex
- W2909812323
- Cited by
- 1,494
- References
- 213
- Citations by year
- 2026: 156 · 2025: 212 · 2024: 213 · 2023: 210 · 2022: 249 · 2021: 258 · 2020: 148 · 2019: 46
- FWCI
- 25.58
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Gastroenterology (acceptedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- HAL (submittedVersion, cc-by-nc)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- Allergan
- National Institute of Environmental Health Sciences
- Gilead Sciences
- Bristol-Myers Squibb
- Boehringer Ingelheim
- National Institutes of Health (P42ES010337)
- 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, nonalcoholic steatohepatitis, non-invasive assessment, liver fibrosis, liver cirrhosis, liver biopsy limitations, steatosis, ballooning, hepatocellular carcinoma
- MeSH terms
- Biopsy, Humans, Liver, Liver Cirrhosis, Liver Function Tests, Magnetic Resonance Imaging, Magnetic Resonance Spectroscopy, Predictive Value of Tests, Prognosis, Severity of Illness Index, Ultrasonography, Reproducibility of Results, Biomarkers, Elasticity Imaging Techniques, Non-alcoholic Fatty Liver Disease
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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