Diagnostic tests for fatty liver disease, NAFLD. FibroScan and MR Elastography. 3

Diagnostic tests for fatty liver disease, NAFLD. FibroScan and MR Elastography. 3

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Let's discuss diagnostic tests to diagnose fatty liver disease. Of course, there are liver enzymes that are used. There are also platelet levels. There are several scores. There is also a notion that over several decades, the upper limit of normal levels for ALT, for example, has risen as a formal upper edge [of normal]. Does that mean that it just reflects the higher prevalence of the subclinical NAFLD? I read the numbers like 25 ALT was 20 years ago the norm. ALT test hasn't changed, and now it's about 40 as upper limit. Well, that's a very important point, Anton. First, let me say that AST, ALT, which are conventional liver tests, are actually enzymes contained within liver cells. And when the liver is damaged, it releases those enzymes. And we can measure that with a standard lab assay. They're often referred to incorrectly as liver function tests. They're really liver injury tests. And the problem is, they're relatively nonspecific. Patients can harbor quite a bit of NASH or NAFLD, and their AST and ALT may not necessarily be elevated. When AST / ALT is elevated, it's not necessarily only from NAFLD. So we need to exclude other causes, in particular viral hepatitis, or perhaps immune disorders or even drug reactions. That, along with platelets, are indicative of some liver problems, but they're just not specific enough to NASH or NAFLD for us to use them as a diagnostic test. It does indicate that we need to do further evaluation either with more imaging, possibly with a FibroScan, and perhaps even with liver biopsy to sort out the reason for those elevated tests [ALT / AST]. So perhaps from a clinical perspective, if fatty liver disease NAFLD is suspected, or if one wants to find out if they have NAFLD or NASH, they should do structural tests such as Transient Elastography or Magnetic Resonance Elastography to ascertain the structure of the liver. They should not just look at the ALT and AST and platelets. Absolutely and certainly, non-invasive imaging is always warranted, particularly ultrasound, to make sure there's nothing focal. Ultrasound is not a good test for liver scarring, but it can determine or identify fat. There are other tests, in particular, MRI Fat fraction [protocol], that can more accurately quantify the amount of fat. MR Elastography gives us an indication of whether there might be scarring. And as you mentioned, tests that measure the stiffness of the liver, particularly a test known as transient elastography. The commercial name that's most commonly used is FibroScan. Dr. Scott Friedman, MD.: But there are other devices that also measure stiffness that can also indicate whether there's any MAFLD / NASH and how advanced relatively it might be.