Bridging Liver Fibrosis

Moving Beyond the Biopsy in NAFLD

In all of the talk about the complications of obesity, much of the focus is on type 2 diabetes. But the health threat may be just as big – or even bigger – from non-alcoholic fatty liver disease (NAFLD). And it can start at an early age. A big part of the problem is that it often goes undiagnosed until it reaches a very advanced stage.

Why? Because right now, a definitive diagnosis requires an invasive, expensive liver biopsy. In other words, to figure out if a person has dangerous liver inflammation, doctors will remove a small sample of liver tissue. It can be painful and bring a risk of bleeding, infection, and accidental damage to other organs.

Resulting Underdiagnosis

For good reasons, doctors hesitate to order a liver biopsy. And the result is underdiagnosis of NAFLD and its advanced form – NASH. Advanced disease brings liver inflammation that can lead to cirrhosis and liver failure. Not good.

Alexander and colleagues recently published the largest study yet on this subject. In more than 17 million patient records, they found evidence for a huge gap in diagnosing NAFLD. In their cohort, they found 30-35 percent of patients with intermediate or high risk scores. But only one percent of patients had a diagnosis of NAFLD in their medical records.

Moving Beyond Biopsies

Now, a new study in Radiology demonstrates that MRI can provide a safe and effective way to monitor fatty liver disease. They studied 126 patients being treated for obesity and showed that MRI was better than BMI or waist circumference for measuring changes in liver fat. “This study shows that the MRI technique is very clinically feasible for monitoring liver fat over time,” said Dustin Pooler, who was the lead author.

Late last year, a group of UK researchers showed that multiparametric MRI could be an accurate tool for diagnosing NAFLD and NASH.

In sum, the technology is maturing. Liver biopsy is a bottleneck. MRI promises to make it easier and more routine to identify fatty liver disease. Letting it go undiagnosed until it ravages a person’s health is a devastating mistake.

Bridging Liver Fibrosis, photograph by Durgesh1104 / Wikimedia Commons

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December 24, 2018

5 Responses to “Moving Beyond the Biopsy in NAFLD”

  1. December 24, 2018 at 8:45 am, Miriam said:

    Worth pointing out that MRI accessibility is very different in the US than elsewhere. Using MRI to diagnose and monitor NAFLD/NASH in Canada isn’t going to happen. Wait times can be up to one year already. No one is going to add those patients into the backlog.

  2. December 24, 2018 at 10:40 am, Ted said:

    Perhaps what you don’t know can’t hurt you . . . until undiagnosed liver disease progresses to a critical state.

  3. December 24, 2018 at 7:17 pm, Ellen Jean Harman said:

    MRI seem simultaneously useful and elusive. When insurance, medicare, medicare is unwilling to pay much related to obesity unless it is couched in something else (and of course NO drugs) — the cost seems prohibitive. How accessible will this be, especially for the part of our population who is barely ensure, or not ensured?

    Seems like a great option/solution — sort of.

  4. December 25, 2018 at 8:31 am, John DiTraglia said:

    There’s really no treatment yet up to liver transplant or bariatric surgery.

  5. December 25, 2018 at 9:09 am, Ted said:

    I’m not one to dismiss the options, even when we need better ones. With good medical care, the impact of NAFLD can be reduced. https://doi.org/10.1002/hep.29367