Selecting noninvasive tests for liver disease diagnosis, monitoring

Noninvasive tests have emerged as valuable alternatives for diagnosing, staging and monitoring MASLD and MASH, according to a recent MedCentral report.

Metabolic dysfunction-associated steatotic liver disease (MASLD) and metabolic dysfunction-associated steatohepatitis (MASH) remain substantially underdiagnosed because of limited awareness, nonspecific or absent symptoms, and a lack of specific diagnostic tests. Timely identification of at-risk patients is therefore essential for risk stratification, long-term disease monitoring and appropriate management.

“The field of noninvasive testing has expanded rapidly and [has] fundamentally changed how clinicians diagnose and stage MASH, offering a broad spectrum of options, ranging from simple serum-based scoring systems to more advanced imaging modalities,” said Adam Myer, MD, assistant professor of clinical medicine in the Division of Gastroenterology and Hepatology in the Department of Internal Medicine at the University of Cincinnati College of Medicine.

Liver biopsy remains the reference standard for diagnosing and staging MASLD and MASH, but its invasive nature, high cost, need for specialized expertise, and risk of complications limit its routine clinical use. As a result, noninvasive tests (NITs), including serum biomarkers, imaging modalities, and predictive algorithms, have emerged as valuable alternatives for diagnosing, staging and longitudinally monitoring these conditions.

According to Myer, no single noninvasive test is perfect.

“When the clinical presentation, laboratory findings and noninvasive testing are discordant, it is best to use multiple modalities to improve diagnostic confidence — for example, combining VCTE with a blood-based fibrosis biomarker such as the ELF score. Integrating multiple sources of information generally provides the most accurate assessment of disease severity,” he advised.

Myer said his approach to test selection is largely determined by the clinical setting, test availability and the patient’s overall risk profile.

“I typically begin with simple, readily available blood-based risk stratification tools, followed by VCTE (FibroScan) for patients who require additional fibrosis assessment,” he added.

Read the full MedCentral article.

Featured image at top: iStock/magicmine.