Novel Noninvasive Tests for Liver Fibrosis: Moving Beyond Simple Tests in Metabolic Dysfunction-associated Steatotic...

Noninvasive tests serve as alternative options to liver biopsy for the diagnosis of liver fibrosis. The Fibrosis 4 (FIB-4) index, aspartate platelet ratio index, and liver stiffness measurement by transient and magnetic resonance elastography are guideline-supported tools for noninvasive liver disease assessment but are limited by indeterminate ranges and varying diagnostic performance among different patient populations. In this scoping review, we evaluate the performance of novel noninvasive liver disease assessments in metabolic dysfunction-associated steatotic liver disease (MASLD) not discussed in recent professional guidelines.

We systematically reviewed the literature over the past 5 years (2020 to present) to identify studies evaluating noninvasive liver disease assessments (NILDAs) in MASLD.

Of the 912 records, 48 met inclusion criteria: 37 through the systematic review and 11 identified by the authors. Of the 15 novel scores, several perform well in steatotic liver disease in validation studies and included routinely available elements. Although several novel scores had good to excellent discrimination, their cost and availability may limit their use in practice. Based on our review, we propose starting with the FIB-4 index, given its availability, low cost, and high negative predictive value. In those with a FIB-4 >1.3, we propose using Agile 3+ or 4 to identify advanced fibrosis or cirrhosis.

NILDAs are effective alternatives to liver biopsy for fibrosis assessment in MASLD and may serve as a tool to identify patients who are candidates for newer therapies.