Identifying patients with NASH and determining their degree of fibrosis are critical for optimal care1

Advances in noninvasive tests (NITs) may help to identify and monitor patients with NASH in the clinical practice setting1-3

  • Although liver biopsy may be useful, NITs help to quantify and assess hepatic steatosis, disease activity, and/or fibrosis and have the potential to assist with patient identification, monitoring, and predicting long-term outcomes1,5,6
  • Accuracy is improved when NITs are used in combination or sequentially, by decreasing the proportion of patients categorized as indeterminate5,7
  • A liver biopsy may be used to confirm diagnosis and can provide helpful information1

Using a structured and systematic approach, you can identify patients with NASH and significant fibrosis* Fibrosis stage F2 or F3 as defined histologically.1,8   in various practice settings1

  • NAFLD/NASH is largely asymptomatic, and optimal timing of treatment is dependent on accurate staging of fibrosis risk1
  • Identifying patients with significant fibrosisFibrosis stage F2 or F3 as defined histologically.1,8 in a timely, evidence-based, and accessible manner is critical so that patients can receive the appropriate management1
  • Below is one approach to evaluate risk and identify patients who may require active management1
Sample clinical care pathway1
1. Patients at risk
  • Two or more metabolic risk factors
  • Type 2 diabetes
  • Steatosis on any imaging modality or elevated aminotransferases
2. History and laboratory tests
  • Excessive alcohol intake
  • Complete blood count (CBC)
  • Liver function tests
3. Diagnosis and risk level

One or more NITs are performed to identify NASH and assess risk:

  • Fibrosis scores and tests (FIB-4, ELF)
  • Liver imaging (FibroScan CAP, FibroScan VCTE, MRI-PDFF, MRE)

Biopsy is rarely performed in clinical practice


Patients identified with significant fibrosisFibrosis stage F2 or F3 as defined histologically.1,8 may benefit from being actively monitored and managed1

ELF=enhanced liver fibrosis panel; FIB-4=fibrosis-4 index; MRE=magnetic resonance elastography; MRI-PDFF=magnetic resonance imaging estimated proton density fat; VCTE=vibration-controlled transient elastography.

Looking for fibrosis?

US NAFLD/NASH guidance and guidelines discuss various NITs that can be used1,2,9

  • Vibration-controlled transient elastography (VCTE)1,2,9,10
  • Magnetic resonance elastography (MRE)1,2,9,10
  • Magnetic resonance imaging (MRI)-estimated proton density fat fraction (PDFF)2,9,10
  • Fibrosis-4 index (FIB-4)1,2,9,10
  • NAFLD fibrosis score (NFS)2,4,9
  • Aspartate aminotransferase (AST) to platelet ratio index (APRI)1,2
  • Enhanced liver fibrosis (ELF) panel2,9
  • Hepascore2
  • FibroSure/FibroTest2,11
  • FibroMeter2
*Fibrosis stage F2 or F3 as defined histologically.

Find additional details about NASH from other established resources