Non-invasive diagnostic methods allow for safe assessment of steatosis and liver fibrosis in NAFLD, reducing the need for biopsy, though assessing inflammatory activity remains challenging.
What are the capabilities, limitations, and prospects of modern non-invasive and minimally invasive methods for diagnosing non-alcoholic fatty liver disease?
Non-invasive imaging and biochemical models can reliably assess steatosis and fibrosis in NAFLD, though identifying active inflammation (NASH) still requires histological examination or novel combined biomarkers.
Purpose of the study to systematize data on modern non-invasive and minimally invasive diagnostic methods for assessing non-alcoholic fatty liver disease (NAFLD), to analyze their capabilities, limitations, and prospects. Material and methods. An analytical review of domestic and foreign publications, clinical guidelines, and meta-analyses on non-invasive and minimally invasive diagnostics of NAFLD was conducted. For each instrumental technique, the determined components of the disease, the measurement principle, the units of measurement used, and the typical indicators of diagnostic efficiency (sensitivity, specificity, and AUROC) are summarized. The biochemical indices are analyzed separately, with the indication of the composition of variables, threshold values, and clinical role. Attention is paid to the insufficient representation of inflammation markers in current models and the prospects for their integration into diagnostics. Results. Modern approaches to the diagnosis of NAFLD have been systematized. A comparison of instrumental methods (ultrasound, computed tomography, magnetic resonance imaging, and elastography) demonstrated their leading role in assessing tissue changes, especially in determining the degree of steatosis and fibrosis. The analysis of biochemical indices showed their significance as first-line tests for dividing patients into risk groups and selecting those who require further examination. The proposed non-invasive models have typical limitations, such as variability of thresholds, influence of accompanying factors, and uncertainty zones, which reduce accuracy in intermediate stages. Conclusion. Modern methods allow for safe and reproducible assessment of steatosis and liver fibrosis in non-alcoholic fatty liver disease, reducing the need for biopsy, especially when using comprehensive algorithms. The challenges of accurately assessing inflammatory activity and identifying non-alcoholic steatohepatitis without histological examination remain unresolved. The development and clinical validation of combined models that integrate imaging indicators with biochemical and immunological biomarkers is a promising area of research. This could potentially improve the early detection of progressive forms of the disease.
Chukhlova et al. (Fri,) conducted a review in Non-alcoholic fatty liver disease (NAFLD). Non-invasive and minimally invasive diagnostic methods was evaluated on Diagnostic efficiency (sensitivity, specificity, and AUROC). Non-invasive diagnostic methods allow for safe assessment of steatosis and liver fibrosis in NAFLD, reducing the need for biopsy, though assessing inflammatory activity remains challenging.