Noninvasive monitoring of hepatic steatosis: controlled attenuation parameter and magnetic resonance imaging-proton density fat fraction in patients with nonalcoholic fatty liver disease

ABSTRACT

Introduction: With an increase in the worldwide prevalence of obesity, the incidence of non-alcoholic fatty liver disease (NAFLD) has been on the rise, such that it has been recently considered to be a major public health concern. Traditional interventions, such as lifestyle modifications, regular exercise, and healthy diet, have been significant in improving NAFLD with reduction of liver fat.

Areas covered: Although liver biopsy is still the gold standard for diagnosis of NAFLD, there is a need for non-invasive, quantitative assessments of hepatic steatosis, especially in clinical trials of anti-steatotic medications or in the follow-up of patients undergoing lifestyle modifications. Liver biopsy has various shortcomings, such as invasive nature, risk of complications and possibility of sampling error. Therefore, it is impractical to use liver biopsy routinely in patients with NAFLD, clearly indicating the need for non-invasive and accurate diagnostic methods. Recently, controlled attenuation parameter (CAP) and magnetic resonance imaging–proton density fat fraction (MRI–PDFF) have been employed in various studies to monitor the dynamic changes of hepatic steatosis in response to treatment in patients with NAFLD.

Expert commentary: Although further validations are required, CAP and MRI–PDFF could be used as potential diagnostic and monitoring tools in clinical setting.

KEYWORDS:

• Controlled attenuation parameter
• proton density fat fraction
• nonalcoholic fatty liver disease
• nonalcoholic steatohepatitis
• hepatic steatosis

Article highlights

• With a significant increase in obesity worldwide, accompanied by a change in diet and lifestyle, the incidence of NAFLD has been on rise.

• Liver biopsy is still the gold standard for diagnosis of NAFLD, however, it has various shortcomings, such as invasive nature, risk of complications and possibility of sampling error.

• There is a need for non-invasive, quantitative assessments of hepatic steatosis, especially in clinical trials of anti-steatotic medications or in the follow-up of patients undergoing lifestyle modifications.

• Controlled attenuation parameter (CAP) and magnetic resonance imaging–proton density fat fraction (MRI–PDFF) are novel, non-invasive techniques with reliable diagnostic accuracy for detection of hepatic steatosis.

• CAP and MRI-PDFF can play a role in screening and diagnosing NAFLD. Actually, they have been employed in various cross-sectional and longitudinal studies to monitor the changes of hepatic steatosis in response to treatment in patients with NAFLD.

• The use of CAP and MRI-PDFF will increase in the near future, complementing liver biopsy, rather than replace it.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.