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Noninvasive Assessment of Liver Disease in Patients With Nonalcoholic Fatty Liver Disease

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Castera, Laurent, Friedrich-Rust, Mireen, Loomba, Rohit·2019·Gastroenterology

DOI 10.1053/j.gastro.2018.12.036PMC PMC7505052

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Abstract

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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Authors: Castera, L., Friedrich-Rust, M., & Loomba, R.
Affiliations: University of California San Diego (US)
ORCID: Castera, Laurent
Loomba, Rohit
Venue: Gastroenterology
Publisher: Elsevier BV
Published: 2019-04
Volume: 156
Issue: 5
Pages: 1264-1281.e4
ISSN: 0016-5085 (ISSN-L)
DOI: 10.1053/j.gastro.2018.12.036
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: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
www.elsevier.com/open-access/userlicense/1.0/ (am, 362 d)
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 › Hepatology › 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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Noninvasive Assessment of Liver Disease in Patients With Nonalcoholic Fatty Liver Disease

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