From the Guidelines
Patients with fatty liver disease should undergo regular monitoring that includes liver function tests every 6-12 months, periodic imaging (ultrasound, FibroScan, or MRI), and assessment of metabolic parameters, as recommended by the most recent guidelines 1. The monitoring approach should be tailored to the individual patient's risk factors and disease severity.
- Blood tests should include ALT, AST, GGT, albumin, bilirubin, complete blood count, lipid profile, and fasting glucose or HbA1c.
- More frequent monitoring (every 3-6 months) is recommended for patients with non-alcoholic steatohepatitis (NASH) or advanced fibrosis.
- Imaging should be performed every 1-2 years to assess disease progression, with conventional ultrasound being the recommended first-line tool for diagnosing steatosis 1.
- Screening for complications like cardiovascular disease and diabetes is important since these conditions frequently coexist with fatty liver.
- Patients with cirrhosis require additional surveillance for hepatocellular carcinoma with ultrasound every 6 months and screening for varices.
- Lifestyle modifications, including weight loss, dietary changes, and physical exercise, remain the cornerstone of treatment, and regular assessment of weight, diet, and physical activity should accompany laboratory and imaging surveillance 1.
- The use of non-invasive tests, such as the fibrosis-4 index (FIB-4) and transient elastography, can help identify advanced fibrosis and rule out cirrhosis 1.
From the Research
Monitoring for Fatty Liver
The following monitoring methods are recommended for patients with Fatty Liver (Steatosis):
- Liver Ultrasound Elastography: This non-invasive technique measures liver stiffness and can detect fibrosis and steatosis 2, 3, 4
- Transient Elastography (FibroScan): This technique measures liver stiffness and can diagnose fibrosis in non-alcoholic fatty liver disease (NAFLD) patients 3, 4
- Magnetic Resonance Elastography (MRE): This technique measures liver stiffness and can detect fibrosis and steatosis in patients with NAFLD 5, 4
- Magnetic Resonance Imaging (MRI): This technique can detect steatosis and fibrosis in patients with NAFLD 5, 4
- Liver Function Tests (LFTs): While LFTs may not be accurate in distinguishing between simple steatosis and non-alcoholic steatohepatitis (NASH), they can still be used to monitor liver function in patients with Fatty Liver 6
Non-Invasive Tests
Non-invasive tests such as elastography and MRI have been shown to be effective in diagnosing fibrosis and steatosis in patients with NAFLD:
- Vibration-controlled transient elastography (VCTE) has a good performance for the diagnosis of severe liver scarring 5
- MRE has a high accuracy for detecting fibrosis and steatosis in patients with NAFLD 5, 4
- MRI-PDFF is more accurate than CAP in detecting all grades of steatosis in patients with NAFLD 4
Diagnostic Accuracy
The diagnostic accuracy of these non-invasive tests varies: