Table 2.
Summary of Recommendations on the Use of Abdominal Ultrasound, FIB-4, NFS, and APRI for the Diagnosis of NAFLD and Assessment of Hepatic Fibrosis Severity.
| Recommendations | Guidelines |
|---|---|
| Ultrasound | |
| Ultrasound is first line for detection of hepatic steatosis | Egyptian guidelines, AISF, KASL, APASL, ALEH, BASL, CSG, EASL, DGVS, AAEH. (10) |
| Ultrasound should be used in conjunction with other tests, but is optional and not necessarily first line | AGA, Catalan guidelines, SBH, INASL. (4) |
| Steatosis is most often discovered incidentally through imaging such as ultrasound, but findings must be in a metabolic context after other causes of steatosis are ruled out | AFEF. (1) |
| Ultrasound is not recommended; TE should be performed instead | AACE. (1) |
| Ultrasound is unproven as a screening tool | AASLD. (1) |
| No comment/does not specify | NICE-UK, JSG, BSG. (3) |
| FIB-4 | |
| Cutoff of <1.3 and >2.67 | AACE, Egyptian guidelines, AGA, KASL, BASL, AFEF. (6) |
| Cutoff of <1.3 and >3.25 | JSG. (1) |
| Cutoff of <1.56 and >3.25 | AASLD. (1) |
| Cutoff of <1.3 | AISF. (1) |
| Cutoff of <1.3 for age <65 | Catalan guidelines. (1) |
| Cutoff of <2 for age ≥65 | |
| Cutoff of <1.3 and >2.67 for age <65 | ALEH, DGVS. (2) |
| Cutoff of >2 and >2.67 for age ≥65 | |
| FIB-4 is recommended, but did not specify cutoffs | APASL, CSG, SBH, EASL, AFEF, BSG. (7) |
| FIB-4 was not mentioned | NICE-UK, INASL. (2) |
| NFS | |
| Cutoffs of <−1.45 and >0.67 | Egyptian guidelines, KASL, APASL, ALEH, BASL, AASLD, JSG, AFEF. (8) |
| Cutoff of <−1.45 and >0.67 for age <65 | DGVS. (1) |
| Cutoff of <0.12 and >0.67 for age ≥65 | |
| Cutoff of <−1.4 for age <65 | Catalan guidelines. (1) |
| Cutoff of <0.12 for age ≥65 | |
| Cutoff of <−1.45 | AISF. (1) |
| NFS is recommended, but did not specify cutoffs | CSG, SBH, EASL, AAEH, BSG, INASL. (6) |
| NFS is not recommended | AACE, AGA. (2) |
| NFS was not mentioned | NICE-UK. (1) |
| APRI | |
| Cutoff of <0.5 and >1.5 | Egyptian guidelines, APASL. (2) |
| Cutoff of <0.48 and >1.34 | AGA. (1) |
| APRI is recommended but did not specify cutoffs | SBH, EASL, INASL (3) |
| APRI is not recommended | ALEH, BASL, AASLD, CSG, DGVS. (5) |
| APRI was not mentioned | AACE, AISF, KASL, Catalan guidelines, BSG, JSG, NICE-UK, AFEF, AAEH. (9) |
Abbreviations: AACE, American Association of Clinical Endocrinology; AAEH, Asociación Española para el Estudio del Hígado; AASLD, American Association for the Study of Liver Diseases; AFEF, French Association for the Study of the Liver; AGA, American Gastroenterology Association; AISF, Italian Association for the Study of the Liver; ALEH, Latin American Association for the study of the liver; APASL, The Asian Pacific Association for the Study of the Liver; APRI, AST to platelet ratio index; BASL, Belgian Association for the Study of the Liver; BSG, British Society of Gastroenterology; CSG, Chinese Society of Gastroenterology; DGVS, German Society of Gastroenterology, Digestive and Metabolic Diseases; EASL, European Association for the Study of the Liver; FIB-4, Fibrosis-4; INASL, India National Association for the Study of the Liver; JSG, Japanese Society of Gastroenterology; KASL, The Korean Association for the Study of the Liver; NFS, NAFLD fibrosis score; NICE, National Institute for Health and Care Excellence.