Abstract
Key issues in patients with nonalcoholic fatty liver disease (NAFLD) are the differentiation
of nonalcoholic steatohepatitis (NASH) from simple steatosis and staging of liver
fibrosis, as patients with NASH/advanced fibrosis are at greatest risk of developing
complications of end-stage liver disease. The controlled attenuation parameter is
the most promising noninvasive technique for detecting and quantifying hepatic steatosis,
but needs to be implemented with the XL probe and compared with ultrasound that, despite
its limitations, remains the most widely used method. Cytokeratin-18 is currently
the most extensively validated serum marker of NASH as a stand-alone test or as part
of prediction models. However, it is not widely available and thus has not been introduced
yet into practice. Transient elastography, as well as FIB-4 and NAFLD fibrosis scores
are the best methods to rule out severe fibrosis and cirrhosis. However, the high
rate of unreliable results with transient elastography remains a challenge, which
is not completely addressed by the use of the XL probe. Given the high prevalence
of NAFLD in the general population, these noninvasive methods could be used in clinical
practice as first-line tools to screen patients with NAFLD to help determine those
who may still require a liver biopsy.
Keywords
nonalcoholic fatty liver disease - noninvasive - steatosis - nonalcoholic steatohepatitis
- fibrosis - serum markers - transient elastography
