Blood tests – AST, ALT, GGT, AST to platelet ratio index (APRI),
fibrosis index-4 (FIB-4), GGT to platelet ratio, and AST/ALT ratio |
Inexpensive, readily available, no failure rate |
Non-specific changes
in liver enzymes or platelets values (hepatic congestion from
cardiorespiratory failure, hepatic inflammation secondary due to drug
induced injury, systemic inflammation) can confound the values. Low
sensitivity and specificity in early stages of aCFLD |
1,11,29 |
Direct biomarkers |
Noninvasive, no failure rate |
Utilized mostly in
research studies and not available widely in clinical settings. Results
can be confounded by advanced lung disease |
24,51,52 |
US |
Noninvasive, available in most centers |
Intra- and interobserver
variabilities exist among radiologists |
12,44,58,60 |
TE |
Noninvasive, simple, and can be performed by non-radiology
clinicians |
Factors such as hepatic inflammation, venous congestion,
ascites, steatosis, and fasting status can interfere with the
interpretation |
39-42,66 |
SWE |
Noninvasive, simple |
Similar limitations as TE. Also needs
expertise in radiology |
28,64 |
MRE |
More accurate and reliable than TE or SWE. The entire liver can be
evaluated with lower sampling error. Can be performed even in patients
with ascites |
May need sedation in young children, expensive and not
widely available for clinical use. Failure rare < 5% due to
inability to breath hold or motion artefacts |
28,77 |
Liver biopsy |
Considered as the gold standard test for evaluating
hepatic fibrosis |
Invasive, the need for sedation, is expensive, have
complications such as pain, bleeding, and tissue sample may
under-represent or over-represent the disease. Intra- and interobserver
variabilities also do exist among pathologists |
4,24,26. |