COMMENTARY

Fatty Liver Takes Center Stage

Digestive Disease Week (DDW) 2013

William F. Balistreri, MD

Disclosures

June 04, 2013

In This Article

Diagnosis of Fatty Liver Disease

Reports also focused on other diagnostic methods, emphasizing that the standard approach (measurement of liver enzymes such as ALT and aspartate aminotransferase) performed poorly for diagnosing fatty liver disease. An elevated ALT:triglyceride ratio was reported to be a simple and noninvasive diagnostic test.[11] In another study,[12] cytokeratin 18 fragment levels were shown to be a surrogate biomarker for the presence of NASH.

Hepatic ultrasonography is the imaging modality most commonly used to screen for steatosis. However, it requires expert interpretation and fails to evaluate the degree of liver injury. Therefore, investigators[13] attempted to quantify and correlate the degree of liver stiffness as measured by sonoelastography imaging during ultrasound examination. They found that the degree of stiffness correlated with elements of the metabolic syndrome such as insulin resistance and the degree of liver injury and fibrosis.

Changes in portal vein blood flow and liver stiffness were also found in another study of patients with NASH.[14] Blood flow and stiffness variables may be used as indices of disease activity, allowing clinicians to monitor changes over time and in response to specific therapies.

A reported pilot study[15] prospectively assessed the diagnostic accuracy of another novel method to measure liver stiffness -- magnetic resonance elastography -- in predicting advanced fibrosis. The method was highly sensitive in predicting stage 3 and 4 fibrosis, so, pending confirmation in a larger cohort, magnetic resonance elastography may be used to noninvasively diagnose advanced fibrosis in patients with fatty liver disease.

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