Noninvasive evaluation of nonalcoholic fatty liver disease: Current evidence and practice

Table 3 Imaging modalities for diagnosing nonalcoholic fatty liver disease related fibrosis

Test	Description	Accuracy	Advantages	Disadvantages	Guideline recommendation
VCTE	Measuring the velocity of a 50 mHz shear wave, which is positively related to liver stiffness	AUROC 0.83, 0.87, and 0.92 , respectively, for AF, SF, and cirrhosis with M probe[28]; AUROC 0.82, 0.86, and 0.94, respectively, for AF, SF, and cirrhosis with XL probe[117]	Relatively low cost; Good reproducibility Short processing time; Can be used in ambulatory clinic setting	Fasting for 2 h; Device- and operator- dependency; Influenced by obesity, congestion, and inflammation; Uncertain cut-off values; Intermediate stages due to two cut-offs	FibroScan can be used to identify those at low or high risk for AF[32,34]
SWE	A method integrated into conventional ultrasound provides a 2-D, real-time, color map of liver elasticity	AUROC 0.86, 0.89, and 0.88, respectively, for AF, SF, and cirrhosis[123]	Good reproducibility; Not affected by obesity or ascites	Relatively high cost; Fasting for 2 h; Device- and operator- dependency; Quality criteria not well defined	NA
ARFI	A method integrated into a conventional ultrasound measures shear wave speed	AUROC 0.77, 0.84, and 0.84, respectively, for AF, SF, and cirrhosis[123]	Good reproducibility; Not affected by obesity or ascites ROI smaller than transient elastography	High cost; Fasting for 2 h; Device- and operator- dependency; Quality criteria not well defined; Intermediate stages due to two cut-offs	NA
MRE	A noninvasive MRI based method measures liver stiffness by a modified phase-contrast method	AUROC 0.87, 0.90, and 0.91, respectively, for AF, SF, and cirrhosis[131]	Good reproducibility; Not affected by obesity or ascites	High cost; Time consuming; Fasting for 2 h; Device- and operator- dependency; Intermediate stages due to two cut-offs	MRE is clinically useful tools for identifying advanced fibrosis in patients with nonalcoholic fatty liver disease[34]

AUROC: Area under the receiver operating characteristic curve; MRE: Magnetic resonance elastography; VCTE: Vibration-controlled transient elastography; SWE: Shear wave elastography; TE: Transient elastography; ARFI: Acoustic radiation force impulse; NA: Not applicable; ROI: Region of interest.