New Way to Identify High-Risk NAFLD Patients

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Subjective reader assessments performed best among several different parameters.

Researchers may have developed a new method in identifying patients at a high risk of developing non-alcoholic fatty liver disease (NAFLD).

A team, led by Meghan G. Lubner, MD, Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Science Center, evaluated the utility of laboratory and CT metrics in identifying which patients are at a higher risk of developing NAFLD.

The study included 186 patients with biopsy-proven NAFLD who underwent CT within 1 year of a biopsy. The mean age of the patient population was 49 years old.

A total of 87 (47%) patients had nonalcoholic steatohepatitis (NASH) and 112 (60%) had moderate to severe steatosis. There were also a total of 51 patients classified as fibrosis stage F0, 42 individuals classified as F2, 37 patients as F3, and 33 participants as F4.

In addition, 70 (38%) individuals had advanced fibrosis—stage F3 or F4—considered to have high-risk for NAFLD.


The researchers performed a histopathologic review to determine steatosis, inflammation, and fibrosis and categorized the presence of any lobular inflammation and hepatocyte ballooning as NASH.

Patients with NAFLD and advanced fibrosis—classified as a stage F3 or higher—were categorized as having high-risk disease. The researchers also calculated aspartate transaminase to platelet ratio indexes and Fibrosis-4 laboratory scores.

The CT metrics in the study included hepatic attenuation, liver segmental volume ration, splenic volume, liver surface nodularity score, and selected texture features.

In addition, a pair of readers subjectively assessed the presence of NASH and fibrosis.


Overall, FIB-4 score correlated with fibrosis (ROC AUC of 0.75 for identifying high-risk NAFLD), while the individual CT parameters, LSVR and splenic volume performed best (AUC of 0.69 for both for detecting high-risk NAFLD).

Subjective reader assessment performed best among all parameters (AUCs pf 0.78 for reader 1 and 0.79 for reader 2 for detecting high-risk NAFLD.

FIB-4 and subjective scores were complementary (combined AUC of 0.82 for detecting high-risk NAFLD) and for NASH assessment, FIB-4 performed best (AUC of 0.68), while the AUCs were less than 0.60 for all individual CT features and subjective assessments.

“FIB-4 and multiple CT findings can identify patients with high-risk NAFLD (advanced fibrosis or cirrhosis),” the authors wrote. “However, the presence of NASH is elusive on CT.”

Challenges with NAFLD

NAFLD is a condition where excess fat is stored in the liver. However, this condition does not usually cause symptoms and is most often found when blood tests indicate elevated liver enzymes.

When the fat builds up, it can cause inflammation and damage, causing NASH, which can lead to scarring of the liver and cirrhosis.

Non-alcoholic fatty liver disease is often linked to obesity, with the prevalence of both diseases becoming increasingly notable. Research indicates that NAFLD is found in 40-80% of individuals who have type 2 diabetes and 30-90% of people who are obese.

However, there is a lack of effective treatments currently available for NAFLD, leading to many researchers taking alternative approaches for new treatments. There are currently no medicines approved by the US Food and Drug Administration (FDA) to treat NAFLD.

The study, “Utility of Multiparametric CT for Identification of High-Risk NAFLD,” was published online in the American Journal of Roentgenology.