Table 1.
Various emerging modalities for nonalcoholic steatohepatitis (NASH) minimally invasive/noninvasive diagnosis: (A) blood clinical biochemistry liver function tests with liver histology as comparator; (B) physical tests US-based or not.
| A. Blood Liver Funtion Tests | Parameter Measured | Pros | Cons | AUROC |
|---|---|---|---|---|
| ELF panel [39] | Hyaluronic acid (HA), Tissue inhibitor metalloproteinase 1 (TIMP1), and Aminoterminal peptide of procollagen 3 (PIIINP). |
Feasible in large number of subjects Good outcome correlation |
Commercial test not routinely available | 0.93 in adults 0.99 in pediatric patients |
| Pro-C3 [42] | Pro collagen III | Able to discriminate simple fatty liver from NASH and different stages of fibrosis | Commercial test | 0.86 |
| NASH NIS4 [44] | MicroRNA 34a-5p; alpha2 macrogobulin (A2M), Haemooglobin A1c (HbA1c), and Chitinase-3-like protein 1 (CHI3L1 also known as YKL40) | This tool can enrich the selection of patients—candidate to experimental trials—with active NASH and significant fibrosis | Commercial test; performances might vary according to the baseline characteristics of the studied population |
0.82 |
| Lipidomic serum test § (OWLiver) [45] |
Two subsequent analyses of 11 and 20 triglycerides panel to be used in adults with BMI > 25 | Able to discriminate normal liver form NAFLD and NAFLD from NASH | Commercial test performed in a centralized laboratory | 0.79 or 0.81 (according to inclusion or exclusion of patients with glucose >136 mg/dl) |
| B.US-Based Physical Tests | Parameter Measured | Pros | Cons | AUROC |
| TE [47,48] | Liver stiffness | Short processing time and outpatient clinic setting |
Measurement failures reported in up to 20% and XL probe required in obese patients |
0.95 for F4 0.93 for F3 0.84 for F2 fibrosis |
| Point shear wave elastgraphy (ARFI) [49] | Liver stiffness | Short processing and outclinic setting |
Quality criteria not well defined, lack of large-scale studies |
0.78–0.89 for F4 0.74–0.97 for F3 0.70–0.83 for F2 fibrosis |
| B. Not US-Based physical tests | Parameter Measured | Pros | Cons | AUROC |
| MRE [50,51] | Liver stiffness | Not influenced by BMI and inflammation | Long processing, expensive, and not largely available |
0.88–0.97 for F4 0.89–0.96 for F3 0.86–0.89 for F2 |
| LiverMultiScan (multiparametric resonance) [52] |
Fibrosis and inflammation mapping | Quick and no contrast agent required | Further validation studies required | 0.85 for F4 |
§ compared to histology.