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World J Gastroenterol. Aug 14, 2012; 18(30): 3945-3954
Published online Aug 14, 2012. doi: 10.3748/wjg.v18.i30.3945
Overview and developments in noninvasive diagnosis of nonalcoholic fatty liver disease
Neven Baršić, Ivan Lerotić, Lea Smirčić-Duvnjak, Vedran Tomašić, Marko Duvnjak
Neven Baršić, Ivan Lerotić, Vedran Tomašić, Marko Duvnjak, Division of Gastroenterology and Hepatology, Department of Medicine, “Sestre milosrdnice” University Hospital Center, 10000 Zagreb, Croatia
Lea Smirčić-Duvnjak, Vuk Vrhovac University Clinic for Diabetes, Endocrinology and Metabolic Diseases, 10000 Zagreb, Croatia
Author contributions: Baršić N, Lerotić I, Smirčić-Duvnjak L and Tomašić V performed the literature search and wrote the paper; and Duvnjak M participated in drafting the outline and revised the paper.
Correspondence to: Marko Duvnjak, Professor, PhD, Division of Gastroenterology and Hepatology, Department of Medicine, “Sestre milosrdnice” University Hospital Center, Vinogradska 29, 10000 Zagreb, Croatia. marko.duvnjak1@gmail.com
Telephone: +385-1-3787549 Fax: +385-1-3787549
Received: December 8, 2011
Revised: March 1, 2012
Accepted: March 9, 2012
Published online: August 14, 2012
Abstract

High prevalence of non-alcoholic fatty liver disease (NAFLD) and very diverse outcomes that are related to disease form and severity at presentation have made the search for noninvasive diagnostic tools in NAFLD one of the areas with most intense development in hepatology today. Various methods have been investigated in the recent years, including imaging methods like ultrasound and magnetic resonance imaging, different forms of liver stiffness measurement, various biomarkers of necroinflammatory processes (acute phase reactants, cytokines, markers of apoptosis), hyaluronic acid and other biomarkers of liver fibrosis. Multicomponent tests, scoring systems and diagnostic panels were also developed with the purposes of differentiating non-alcoholic steatohepatitis from simple steatosis or discriminating between various fibrosis stages. In all of the cases, performance of noninvasive methods was compared with liver biopsy, which is still considered to be a gold standard in diagnosis, but is by itself far from a perfect comparative measure. We present here the overview of the published data on various noninvasive diagnostic tools, some of which appear to be very promising, and we address as well some of still unresolved issues in this interesting field.

Keywords: Non-alcoholic fatty liver disease; Non-alcoholic steatohepatitis; Liver fibrosis; Liver biopsy; Biomarkers; Transient elastography; Cytokeratin-18; Oxidative stress; Insulin resistance; Hyaluronic acid