From the Guidelines
A repeat ultrasound would be helpful for monitoring disease progression in patients with hepatic steatosis, particularly in those with cardiometabolic risk factors, abnormal liver enzymes, and/or radiological signs of hepatic steatosis. According to the latest guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD) 1, a stepwise approach using non-invasive tests, including imaging techniques like ultrasound, is suitable for ruling out advanced fibrosis, which is predictive of liver-related outcomes.
Key Components of Follow-up
- Regular monitoring every 6-12 months with liver function tests, lipid profiles, and assessment of metabolic parameters
- Periodic imaging with ultrasound, typically annually, to monitor disease progression
- Lifestyle modification, focusing on gradual weight loss, a balanced diet, and regular exercise
- Optimal control of associated conditions like diabetes, hypertension, and dyslipidemia
Management Strategies
- Lifestyle modification, including weight loss, dietary changes, physical exercise, and discouraging alcohol consumption, is advised for adults with MASLD 1
- Optimal management of comorbidities, including the use of incretin-based therapies for type 2 diabetes or obesity, if indicated, is also recommended 1
- Bariatric surgery is an option in individuals with MASLD and obesity, and certain medications like resmetirom may be considered for non-cirrhotic MASH with significant liver fibrosis, depending on local approval and label indications 1
From the Research
Follow-up for Hepatic Steatosis
If the initial ultrasound shows hepatic steatosis, a repeat ultrasound would be helpful for:
- Assessing treatment response using proton-density fat fraction as a biomarker 2
- Monitoring the progression of nonalcoholic fatty liver disease (NAFLD) to steatohepatitis or cirrhosis 2, 3
- Evaluating the effectiveness of treatment in reducing hepatic fat 2, 4
- Diagnosing the stage of hepatic steatosis, with ultrasound-guided attenuation parameter (UGAP) measurements showing high diagnostic performance 5
Non-invasive Assessment Methods
Non-invasive assessment methods for hepatic steatosis and fibrosis include:
- Ultrasound B-mode imaging, although this is qualitative and subjective 6
- Controlled attenuation parameter (CAP) determined using FibroScan, which is an evidence-based non-invasive measure of liver steatosis 6
- Liver stiffness measurement (LSM) determined using FibroScan, which is an evidence-based non-invasive measure of liver fibrosis 6
- Magnetic resonance (MR) elastography and functional evaluation with Gd-EOB-DTPA, which are becoming important for monitoring the progression of NAFLD 2
- Quantitative ultrasound-based imaging techniques, which possess many inherent advantages and are less operator dependent than traditional ultrasound 4