Noninvasive imaging methods to determine severity of nonalcoholic fatty liver disease and nonalcoholic steatohepatitis

Abstract

Nonalcoholic fatty liver disease (NAFLD) is now the most common form of liver disease in developed countries, with an estimated prevalence of 20%-30% and increasing to as high as 90% in diabetics. As the rates of NAFLD continue to rise in parallel with those of the obesity pandemic, it is increasingly important to differentiate those patients with the highest risk of progression to fibrosis and cirrhosis. In fact, those patients with nonalcoholic steatohepatitis (NASH) and fibrosis are at the greatest risk of progression to advanced disease, cirrhosis, and hepatocellular cancer and are more likely to develop liver-related mortality. Thus, it is critically important to distinguish between NASH and non-NASH NAFLD. Whereas liver biopsy remains the gold standard for staging of disease, complications of this procedure and other well-recognized limitations make it impractical for widespread use given the overall NAFLD disease burden. Noninvasive imaging modalities are increasingly being utilized to evaluate and stage NAFLD in patients with such a wide spectrum of disease. In this article, the role of these new and promising noninvasive imaging modalities to assess disease severity in NAFLD are reviewed. (Hepatology 2016;64:2234-2243).

Persistently altered liver test results in hepatitis C patients after sustained virological response with direct‐acting antivirals

“…We conducted our study in a real‐world clinical setting, where liver biopsy was at the discretion of the attending physician. On the one hand, a reliable ultrasound diagnosis of fatty liver is more difficult in patients with concomitant liver fibrosis, as was the case in the HCV‐infected patients in our study. On the other hand, noninvasive serological risk scores of fibrosis and TE in nonalcoholic fatty liver disease have been developed and validated in populations with a single liver disease and could be influenced by HCV‐induced fibrosis.…”

“…The causes of PALT were established by practitioners according to the standard clinical criteria . As several studies have demonstrated, ultrasound cannot reliably distinguish between fibrosis and steatosis, and almost all of our patients had HCV‐induced liver fibrosis. Therefore, the patients were diagnosed as clinically suggestive of nonalcoholic fatty liver disease if no other liver disease was confirmed and risk factors for metabolic syndrome were present.…”

A multi-component classifier for nonalcoholic fatty liver disease (NAFLD) based on genomic, proteomic, and phenomic data domains

“…The cause of NAFLD appears to be multifactorial46, although lifestyle (i.e., over-nutrition) plays a significant role by contributing to the development of obesity47. Both genetic variants283948 and protein biomarkers49 have also been associated with NAFLD. Due to the underlying complexity of NAFLD pathogenesis, we sought to develop an algorithm based on the unbiased assessment of large groups of variables, i.e., using “omics” approaches, in several data domains that could differentiate NAFLD in a population with extreme obesity.…”

“…Imaging techniques have also been used to assess NAFLD, including liver ultrasound, a relatively inexpensive modality with relatively high sensitivity for moderate to severe steatosis, magnetic resonance imaging (MRI) and magnetic resonance spectroscopy, both relatively expensive with limited availability, as well as computed tomography (CT) and transient ultrasound elastography27. However, none of the current imaging modalities are logistically or economically viable to broadly apply to the population at risk for NAFLD except as an adjunct to biopsy28.…”

Towards a systems approach for chronic diseases, based on health state modeling

“…The transition from NAFLD to NASH is loaded with many questions, including the biology of this transition, the best ways to recognize it as early as possible in patients (e.g. Hannah & Harrison, 2016), and multiple economic consequences, such as the most efficient use of healthcare resources. While much progress has been made in understanding those aspects, a more collaborative approach across stakeholders is increasingly gathering momentum, including projects managed under the IMI umbrella (a framework for multi-stakeholder collaborations related to health, with public-private partnership at its core).…”